Provider Demographics
NPI:1972679629
Name:SCARSDALE PHYSICAL THERAPY AND SPORTS REHABILITATION SERVICES PC
Entity Type:Organization
Organization Name:SCARSDALE PHYSICAL THERAPY AND SPORTS REHABILITATION SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-346-5174
Mailing Address - Street 1:83 MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583
Mailing Address - Country:US
Mailing Address - Phone:914-472-6686
Mailing Address - Fax:914-472-6757
Practice Address - Street 1:83 MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583
Practice Address - Country:US
Practice Address - Phone:914-472-6686
Practice Address - Fax:914-472-6757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5C7219OtherHEALTHNET
NYANC1593OtherOXFORD
NYQ1WGC1Medicare ID - Type Unspecified