Provider Demographics
NPI:1538671870
Name:EMPIRE ORTHOPEDIC PHYSICAL THERAPY AND REHABILITATION, PLLC
Entity Type:Organization
Organization Name:EMPIRE ORTHOPEDIC PHYSICAL THERAPY AND REHABILITATION, PLLC
Other - Org Name:EMPIRE SPORTS PHYSICAL THERAPY AND REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:STEDJAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-535-9825
Mailing Address - Street 1:53 CAPRAL LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3523
Mailing Address - Country:US
Mailing Address - Phone:856-371-7775
Mailing Address - Fax:
Practice Address - Street 1:15 LAKE RIDGE PLZ
Practice Address - Street 2:
Practice Address - City:VALLEY COTTAGE
Practice Address - State:NY
Practice Address - Zip Code:10989-1925
Practice Address - Country:US
Practice Address - Phone:845-535-9825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-26
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy