Provider Demographics
NPI:1518104850
Name:NEW BALANCE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:NEW BALANCE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERON
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:631-226-2918
Mailing Address - Street 1:608 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3528
Mailing Address - Country:US
Mailing Address - Phone:631-226-2918
Mailing Address - Fax:631-226-2745
Practice Address - Street 1:608 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3528
Practice Address - Country:US
Practice Address - Phone:631-226-2918
Practice Address - Fax:631-226-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026543225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty