Provider Demographics
NPI:1568590198
Name:UTSTEIN & GOW P.T., P.C.
Entity Type:Organization
Organization Name:UTSTEIN & GOW P.T., P.C.
Other - Org Name:PHYSIO SPORTS CENTER WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:GOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-877-5580
Mailing Address - Street 1:1995 BROADWAY
Mailing Address - Street 2:15TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5882
Mailing Address - Country:US
Mailing Address - Phone:212-877-5580
Mailing Address - Fax:212-877-0388
Practice Address - Street 1:1995 BROADWAY
Practice Address - Street 2:15TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5882
Practice Address - Country:US
Practice Address - Phone:212-877-5580
Practice Address - Fax:212-877-0388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012458261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP492310OtherOXFORD
NYP492310OtherOXFORD