Provider Demographics
NPI:1255637559
Name:JMP PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:JMP PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTALEO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-641-8700
Mailing Address - Street 1:157- 05 CROSSBAY BLVD.
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414
Mailing Address - Country:US
Mailing Address - Phone:718-641-8700
Mailing Address - Fax:718-641-8702
Practice Address - Street 1:15705 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2748
Practice Address - Country:US
Practice Address - Phone:718-641-8700
Practice Address - Fax:718-641-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027737261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100035520Medicare PIN