Provider Demographics
NPI:1881789873
Name:NEW AGE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:NEW AGE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIRAV
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-270-5527
Mailing Address - Street 1:80 I U WILLETS RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3038
Mailing Address - Country:US
Mailing Address - Phone:516-270-5527
Mailing Address - Fax:516-908-5441
Practice Address - Street 1:3249 FRANCIS LEWIS BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1923
Practice Address - Country:US
Practice Address - Phone:718-224-3818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07395Medicare ID - Type Unspecified
NYQ6W6U1Medicare ID - Type Unspecified