Provider Demographics
NPI:1578602934
Name:STATEN ISLAND PHYSCIAL THERAPY PC
Entity Type:Organization
Organization Name:STATEN ISLAND PHYSCIAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:718-317-2006
Mailing Address - Street 1:4906 ARTHUR KILL RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2601
Mailing Address - Country:US
Mailing Address - Phone:718-317-2006
Mailing Address - Fax:718-317-2016
Practice Address - Street 1:4906 ARTHUR KILL RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2601
Practice Address - Country:US
Practice Address - Phone:718-317-2006
Practice Address - Fax:718-317-2016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0254831225100000X
NY0252871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5W2B1Medicare PIN