Provider Demographics
NPI:1750828547
Name:EAST & WEST PHYSICAL THERAPIST & ACUPUNCTURE PLLC
Entity type:Organization
Organization Name:EAST & WEST PHYSICAL THERAPIST & ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:STANISLAWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-419-7601
Mailing Address - Street 1:81 ELIZABETH ST
Mailing Address - Street 2:STE 303
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4729
Mailing Address - Country:US
Mailing Address - Phone:212-219-8987
Mailing Address - Fax:212-219-8982
Practice Address - Street 1:750 56TH ST
Practice Address - Street 2:#1 FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4196
Practice Address - Country:US
Practice Address - Phone:718-871-8899
Practice Address - Fax:718-871-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227681Medicaid
NYQN0322Medicare PIN