Provider Demographics
NPI:1356530182
Name:BROWNSTONE PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:BROWNSTONE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARKE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT, ATC, OCS
Authorized Official - Phone:315-986-4655
Mailing Address - Street 1:1900 STATE ROUTE 31
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8943
Mailing Address - Country:US
Mailing Address - Phone:315-986-4655
Mailing Address - Fax:315-986-5901
Practice Address - Street 1:1900 STATE ROUTE 31
Practice Address - Street 2:SUITE 12
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8943
Practice Address - Country:US
Practice Address - Phone:315-986-4655
Practice Address - Fax:315-986-5901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008672261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01684335Medicaid
NY01684335Medicaid