Provider Demographics
NPI:1669660270
Name:HANDSON PHYSICAL THERAPY BAYSIDE
Entity Type:Organization
Organization Name:HANDSON PHYSICAL THERAPY BAYSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MGR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:BILLER
Authorized Official - Phone:718-707-6970
Mailing Address - Street 1:4401 FRANCIS LEWIS BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3002
Mailing Address - Country:US
Mailing Address - Phone:718-224-2867
Mailing Address - Fax:718-224-3782
Practice Address - Street 1:4401 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3002
Practice Address - Country:US
Practice Address - Phone:718-224-2867
Practice Address - Fax:718-224-3782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HANDSON PHYSICAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028321-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty