Provider Demographics
NPI:1952647885
Name:RIVERSIDE PHYSICAL THERAPY,NYC,PLLC
Entity Type:Organization
Organization Name:RIVERSIDE PHYSICAL THERAPY,NYC,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-580-0125
Mailing Address - Street 1:250 W 93RD ST
Mailing Address - Street 2:LL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7391
Mailing Address - Country:US
Mailing Address - Phone:212-580-0125
Mailing Address - Fax:212-580-0860
Practice Address - Street 1:250 W 93RD ST
Practice Address - Street 2:LL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7391
Practice Address - Country:US
Practice Address - Phone:212-580-0125
Practice Address - Fax:212-580-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty