Provider Demographics
NPI:1811387459
Name:GREENSTONE PHYSICAL & MASSAGE THERAPY PLLC
Entity Type:Organization
Organization Name:GREENSTONE PHYSICAL & MASSAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:POPA RICKETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-767-9512
Mailing Address - Street 1:133 WATER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1056
Mailing Address - Country:US
Mailing Address - Phone:718-875-1514
Mailing Address - Fax:718-722-7195
Practice Address - Street 1:133 WATER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1056
Practice Address - Country:US
Practice Address - Phone:718-875-1514
Practice Address - Fax:718-722-7195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-05-14
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020574OtherLICENSE