Provider Demographics
NPI:1821102591
Name:EASTSIDE KINESTHETIC CENTER
Entity Type:Organization
Organization Name:EASTSIDE KINESTHETIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-308-5047
Mailing Address - Street 1:133 E 55TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3502
Mailing Address - Country:US
Mailing Address - Phone:212-308-5047
Mailing Address - Fax:212-308-5128
Practice Address - Street 1:133 E 55TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3502
Practice Address - Country:US
Practice Address - Phone:212-308-5047
Practice Address - Fax:212-308-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0106042251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ18L51Medicare UPIN