Provider Demographics
NPI:1790817989
Name:NASSAU REHABILITATION &SPORTS THERAPY
Entity type:Organization
Organization Name:NASSAU REHABILITATION &SPORTS THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:SAFALOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-741-9600
Mailing Address - Street 1:137 WILLIS AVE
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2658
Mailing Address - Country:US
Mailing Address - Phone:516-741-9600
Mailing Address - Fax:516-741-8051
Practice Address - Street 1:137 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2658
Practice Address - Country:US
Practice Address - Phone:516-741-9600
Practice Address - Fax:516-741-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00003046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNA0Q5WQP10Medicare ID - Type Unspecified