Provider Demographics
NPI:1528415940
Name:OCEAN PARKWAY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:OCEAN PARKWAY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STAROSTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-957-8100
Mailing Address - Street 1:3080 W 1ST ST
Mailing Address - Street 2:UNIT 201
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3736
Mailing Address - Country:US
Mailing Address - Phone:917-957-8100
Mailing Address - Fax:
Practice Address - Street 1:3044 CONEY ISLAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5660
Practice Address - Country:US
Practice Address - Phone:917-957-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018713174400000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1205896040OtherNPI INDIVIDUAL
NY02193199Medicaid