Provider Demographics
NPI:1629026026
Name:POR, NICHOLAS (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:POR
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PARK AVE
Mailing Address - Street 2:GROUND FL.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10166-0005
Mailing Address - Country:US
Mailing Address - Phone:212-953-9494
Mailing Address - Fax:212-682-2013
Practice Address - Street 1:200 PARK AVE
Practice Address - Street 2:GROUND FL.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10166-0005
Practice Address - Country:US
Practice Address - Phone:212-953-9494
Practice Address - Fax:212-682-2013
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022183-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist