Provider Demographics
NPI:1528386570
Name:CHARMEL PHYSICAL THERAPY OF NEW YORK, PLLC
Entity Type:Organization
Organization Name:CHARMEL PHYSICAL THERAPY OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY CHARMEL
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:SAMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:516-374-5934
Mailing Address - Street 1:1200 W BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1913
Mailing Address - Country:US
Mailing Address - Phone:516-374-5934
Mailing Address - Fax:888-878-8076
Practice Address - Street 1:1200 W BROADWAY
Practice Address - Street 2:SUITE 1
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1913
Practice Address - Country:US
Practice Address - Phone:516-374-5934
Practice Address - Fax:888-878-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty