Provider Demographics
NPI:1922159359
Name:PERFORM PHYSICAL THERAPY AND PILATES PLLC
Entity Type:Organization
Organization Name:PERFORM PHYSICAL THERAPY AND PILATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT,MS,OCS,CPI
Authorized Official - Phone:516-220-4177
Mailing Address - Street 1:141 LIDO BLVD
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4833
Mailing Address - Country:US
Mailing Address - Phone:516-220-4177
Mailing Address - Fax:516-992-2282
Practice Address - Street 1:141 LIDO BLVD
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4833
Practice Address - Country:US
Practice Address - Phone:516-220-4177
Practice Address - Fax:516-992-2282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013055261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY803355OtherMPN
NY1495973OtherCIGNA PROV #
NYQ35E42OtherBCBS PROV #
0024301OtherORTHONET
NY11303OtherMAGNACARE PROV #
NY1174577217OtherINDIVIDUAL NPI
NY0123036OtherGHI PROV #
NY6C5374OtherHEALTHNET
NY133998OtherVYTRA PROV #
NY107959POtherHIP PROV #
NY2607498OtherUHC
NY803355OtherMPN
NYQAWDF1Medicare PIN