Provider Demographics
NPI:1649560244
Name:E-W PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:E-W PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:718-344-7637
Mailing Address - Street 1:1957 CONEY ISLAND AVE
Mailing Address - Street 2:957 CONEY ISLAND AVE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2328
Mailing Address - Country:US
Mailing Address - Phone:718-339-6425
Mailing Address - Fax:718-715-1437
Practice Address - Street 1:1957 CONEY ISLAND AVE
Practice Address - Street 2:957 CONEY ISLAND AVE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2328
Practice Address - Country:US
Practice Address - Phone:718-339-6425
Practice Address - Fax:718-715-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021243-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty