Provider Demographics
NPI:1710068465
Name:CHAD JOSEPH CARDILLO
Entity Type:Organization
Organization Name:CHAD JOSEPH CARDILLO
Other - Org Name:ELITE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CARDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-797-0111
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:SAUQUOIT
Mailing Address - State:NY
Mailing Address - Zip Code:13456-0465
Mailing Address - Country:US
Mailing Address - Phone:315-736-2080
Mailing Address - Fax:315-736-2162
Practice Address - Street 1:9643 PINNACLE RD
Practice Address - Street 2:
Practice Address - City:SAUQUOIT
Practice Address - State:NY
Practice Address - Zip Code:13456-3041
Practice Address - Country:US
Practice Address - Phone:315-737-7300
Practice Address - Fax:315-735-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0588Medicare PIN