Provider Demographics
NPI:1487110888
Name:KINESIOWORKS PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:KINESIOWORKS PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:DR
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:MARUCUT
Authorized Official - Last Name:STO TOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:718-839-3046
Mailing Address - Street 1:38 DEERFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-1805
Mailing Address - Country:US
Mailing Address - Phone:201-968-6112
Mailing Address - Fax:201-561-0158
Practice Address - Street 1:1980 AMSTERDAM AVE # 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-5058
Practice Address - Country:US
Practice Address - Phone:212-740-2049
Practice Address - Fax:917-388-3417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05357539Medicaid