Provider Demographics
NPI:1922307198
Name:SOUTH SHORE ADVANCED PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:SOUTH SHORE ADVANCED PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NEMESIO
Authorized Official - Middle Name:C
Authorized Official - Last Name:FELIX
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:718-227-0198
Mailing Address - Street 1:PO BOX 140146
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-0146
Mailing Address - Country:US
Mailing Address - Phone:718-227-0198
Mailing Address - Fax:718-948-0772
Practice Address - Street 1:456 ARLENE ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3814
Practice Address - Country:US
Practice Address - Phone:718-494-0675
Practice Address - Fax:718-948-0772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-27
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016967-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty