Provider Demographics
NPI:1861637746
Name:JAMES GOTT PHYSCIAL THERAPY
Entity Type:Organization
Organization Name:JAMES GOTT PHYSCIAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD PT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID WENGER
Authorized Official - Middle Name:
Authorized Official - Last Name:WENGER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:516-328-2288
Mailing Address - Street 1:2035 LAKEVILLE RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1661
Mailing Address - Country:US
Mailing Address - Phone:516-328-2288
Mailing Address - Fax:516-358-6946
Practice Address - Street 1:184 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4223
Practice Address - Country:US
Practice Address - Phone:516-747-5042
Practice Address - Fax:516-358-6946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4082261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5280CK201Medicare PIN