Provider Demographics
NPI:1659355956
Name:NY PHYSICAL THERAPY & WELLNESS LLC
Entity Type:Organization
Organization Name:NY PHYSICAL THERAPY & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-358-8911
Mailing Address - Street 1:820 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-4342
Mailing Address - Country:US
Mailing Address - Phone:516-358-8911
Mailing Address - Fax:516-358-8960
Practice Address - Street 1:820 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-4342
Practice Address - Country:US
Practice Address - Phone:516-358-8911
Practice Address - Fax:516-358-8960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherPHCS
NY=========OtherAETNA
NY=========OtherBEECH STREET
NY=========OtherMPN
NY=========Other1199
NY=========OtherHORIZON
NY=========OtherCIGNA
NY=========OtherMAGNACARE
NY=========OtherHUMANA
NY=========OtherINTEGRATED HEALTH PLAN