Provider Demographics
NPI:1508160581
Name:PROHEALTH AND FITNESS PT OT PLLC
Entity Type:Organization
Organization Name:PROHEALTH AND FITNESS PT OT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-600-4781
Mailing Address - Street 1:180 W END AVE
Mailing Address - Street 2:SUITE 1M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4902
Mailing Address - Country:US
Mailing Address - Phone:212-600-4781
Mailing Address - Fax:800-655-3780
Practice Address - Street 1:180 W END AVE
Practice Address - Street 2:SUITE 1M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4902
Practice Address - Country:US
Practice Address - Phone:212-600-4781
Practice Address - Fax:800-655-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03271592Medicaid
NY6493060001Medicare NSC
NYA100033161Medicare PIN