Provider Demographics
NPI:1821306762
Name:PHYSICORE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PHYSICORE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:212-247-9605
Mailing Address - Street 1:20 AVE AT PORT IMPERIAL APT 510
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-8423
Mailing Address - Country:US
Mailing Address - Phone:212-247-9605
Mailing Address - Fax:212-247-9606
Practice Address - Street 1:939 8TH AVE APT 207
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4205
Practice Address - Country:US
Practice Address - Phone:212-247-9605
Practice Address - Fax:212-247-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020574174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty