Provider Demographics
NPI:1578778965
Name:EVELINE ERNI, PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EVELINE ERNI, PHYSICAL THERAPY
Other - Org Name:PIVOTAL PHYSICAL THERAPY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-317-9798
Mailing Address - Street 1:30 W 57TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3916
Mailing Address - Country:US
Mailing Address - Phone:212-317-9798
Mailing Address - Fax:212-245-5935
Practice Address - Street 1:30 W 57TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3916
Practice Address - Country:US
Practice Address - Phone:212-317-9798
Practice Address - Fax:212-245-5935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0103911225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ64581Medicare ID - Type Unspecified