Provider Demographics
NPI:1174767958
Name:PLATINUM WELLNESS PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:PLATINUM WELLNESS PHYSICAL THERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-452-2400
Mailing Address - Street 1:400 E 74TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3912
Mailing Address - Country:US
Mailing Address - Phone:212-452-2400
Mailing Address - Fax:
Practice Address - Street 1:400 E 74TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3912
Practice Address - Country:US
Practice Address - Phone:212-452-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-24
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1770535379OtherINDIVIDUAL NPI
A300000048OtherMEDICARE PTAN