Provider Demographics
NPI:1174681399
Name:PHYSICAL THERAPY SERVICES OF NY, PC
Entity type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF NY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAE
Authorized Official - Middle Name:
Authorized Official - Last Name:DACHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-214-4049
Mailing Address - Street 1:177 WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2526
Mailing Address - Country:US
Mailing Address - Phone:516-214-4049
Mailing Address - Fax:516-214-4057
Practice Address - Street 1:177 WOODFIELD RD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2526
Practice Address - Country:US
Practice Address - Phone:516-214-4049
Practice Address - Fax:516-214-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ10V71Medicare ID - Type Unspecified