Provider Demographics
NPI:1932437134
Name:MICCASS PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:MICCASS PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-595-4500
Mailing Address - Street 1:180 W 80TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6301
Mailing Address - Country:US
Mailing Address - Phone:212-595-4500
Mailing Address - Fax:212-595-4578
Practice Address - Street 1:180 W 80TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6301
Practice Address - Country:US
Practice Address - Phone:212-595-4500
Practice Address - Fax:212-595-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-27
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy