Provider Demographics
NPI:1396780482
Name:A TO Z PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:A TO Z PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PRORIETER
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:
Authorized Official - Last Name:KANDURI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-318-5303
Mailing Address - Street 1:113 TIVED LN E
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837-3077
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8610 151ST AVE
Practice Address - Street 2:SUITE # LK
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1332
Practice Address - Country:US
Practice Address - Phone:917-318-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100098026OtherMEDICARE PTAN