Provider Demographics
NPI:1508977745
Name:ANGELO ROSATO PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ANGELO ROSATO PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:C
Authorized Official - Last Name:ROSATO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-266-0010
Mailing Address - Street 1:600 FRENCH RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1037
Mailing Address - Country:US
Mailing Address - Phone:315-266-0010
Mailing Address - Fax:315-266-0147
Practice Address - Street 1:600 FRENCH RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1037
Practice Address - Country:US
Practice Address - Phone:315-266-0010
Practice Address - Fax:315-266-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010651-12251X0800X
NY015432-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02292717Medicaid
NYAA1326Medicare PIN