Provider Demographics
NPI:1629195391
Name:PALISADES PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:PALISADES PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:P
Authorized Official - Last Name:KALOTKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-359-3950
Mailing Address - Street 1:1 SCOTTI AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADES
Mailing Address - State:NY
Mailing Address - Zip Code:10964-1319
Mailing Address - Country:US
Mailing Address - Phone:845-359-3950
Mailing Address - Fax:845-359-3950
Practice Address - Street 1:1 SCOTTI AVE
Practice Address - Street 2:
Practice Address - City:PALISADES
Practice Address - State:NY
Practice Address - Zip Code:10964-1319
Practice Address - Country:US
Practice Address - Phone:845-359-3950
Practice Address - Fax:845-359-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY24559225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
120-7330OtherAETNA HMO
Q30N31OtherEMPIRE BLUE CROSS BLUE SHIELD
238-4959OtherUNITED HEALTH CARE
740-4779OtherAETNA PPO
0300150OtherUS FAMILY HEALTH PLAN
0300150OtherCIGNA
SEIU-133-207Other1199 SEIU
Q6W6A1Medicare PIN