Provider Demographics
NPI:1710308846
Name:STATEN ISLAND CENTER FOR ALTERNATIVE THERAPIES, LLP
Entity Type:Organization
Organization Name:STATEN ISLAND CENTER FOR ALTERNATIVE THERAPIES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOMENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-605-1300
Mailing Address - Street 1:520 BLOOMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2061
Mailing Address - Country:US
Mailing Address - Phone:718-605-1300
Mailing Address - Fax:718-605-8739
Practice Address - Street 1:520 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2061
Practice Address - Country:US
Practice Address - Phone:718-605-1300
Practice Address - Fax:718-605-8739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty