Provider Demographics
NPI:1700417201
Name:CORNWELL AVE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:CORNWELL AVE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:NASRINPAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:703-371-9985
Mailing Address - Street 1:7883 SENECA TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323
Mailing Address - Country:US
Mailing Address - Phone:703-371-9985
Mailing Address - Fax:
Practice Address - Street 1:7883 SENECA TURNPIKE
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323
Practice Address - Country:US
Practice Address - Phone:703-371-9985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-03
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy