Provider Demographics
NPI:1598040016
Name:PHYSICAL THERAPY SPECIALISTS OF NEW YORK, PLLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SPECIALISTS OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:PADERON
Authorized Official - Last Name:MABEZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-307-1281
Mailing Address - Street 1:313 NASSAU BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5313
Mailing Address - Country:US
Mailing Address - Phone:516-307-1281
Mailing Address - Fax:516-307-1282
Practice Address - Street 1:313 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-5313
Practice Address - Country:US
Practice Address - Phone:516-307-1281
Practice Address - Fax:516-307-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty