Provider Demographics
NPI:1457710642
Name:COSMOPOLITAN PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:COSMOPOLITAN PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-255-7063
Mailing Address - Street 1:9932 62ND AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1470
Mailing Address - Country:US
Mailing Address - Phone:347-255-7063
Mailing Address - Fax:
Practice Address - Street 1:3751 75TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON HTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6422
Practice Address - Country:US
Practice Address - Phone:718-424-9899
Practice Address - Fax:718-424-8702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03397784Medicaid