Provider Demographics
NPI:1629480793
Name:BRILLIANT HEALTH SERVICES
Entity Type:Organization
Organization Name:BRILLIANT HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-333-7224
Mailing Address - Street 1:1560 BROADWAY 10TH FL
Mailing Address - Street 2:SUITE 1007
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036
Mailing Address - Country:US
Mailing Address - Phone:212-333-7224
Mailing Address - Fax:
Practice Address - Street 1:1560 BROADWAY FL 10
Practice Address - Street 2:SUITE 1007
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-1537
Practice Address - Country:US
Practice Address - Phone:212-333-7224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251E1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistErgonomicsGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty