Provider Demographics
NPI:1245325745
Name:SUPERIOR WELLNESS OF NEW YORK PHYSICAL THERAPY
Entity type:Organization
Organization Name:SUPERIOR WELLNESS OF NEW YORK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P.T.
Authorized Official - Prefix:
Authorized Official - First Name:MARY JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:CUBILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSPT
Authorized Official - Phone:516-596-2273
Mailing Address - Street 1:210 E SUNRISE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1329
Mailing Address - Country:US
Mailing Address - Phone:516-596-2273
Mailing Address - Fax:516-596-9606
Practice Address - Street 1:210 E SUNRISE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1329
Practice Address - Country:US
Practice Address - Phone:516-596-2273
Practice Address - Fax:516-596-9606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP41219Medicare UPIN