Provider Demographics
NPI:1639445489
Name:DELTA PHYSICAL THERAPY REHAB PC
Entity Type:Organization
Organization Name:DELTA PHYSICAL THERAPY REHAB PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-934-3223
Mailing Address - Street 1:1601 GRAVESEND NECK RD
Mailing Address - Street 2:SPACE#11
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4426
Mailing Address - Country:US
Mailing Address - Phone:718-934-3223
Mailing Address - Fax:718-934-3336
Practice Address - Street 1:1601 GRAVESEND NECK RD
Practice Address - Street 2:SPACE#11
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4426
Practice Address - Country:US
Practice Address - Phone:718-934-3223
Practice Address - Fax:718-934-3336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023424225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty