Provider Demographics
NPI:1942374418
Name:NEW YORK GAO PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:NEW YORK GAO PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:X
Authorized Official - Last Name:GAO
Authorized Official - Suffix:
Authorized Official - Credentials:DIPL AC LAC PT DPT
Authorized Official - Phone:212-625-9290
Mailing Address - Street 1:401 BROADWAY
Mailing Address - Street 2:SUITE 1808
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-3018
Mailing Address - Country:US
Mailing Address - Phone:212-625-9290
Mailing Address - Fax:212-925-3101
Practice Address - Street 1:401 BROADWAY
Practice Address - Street 2:SUITE 1808
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-3018
Practice Address - Country:US
Practice Address - Phone:212-625-9290
Practice Address - Fax:212-925-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0022221171100000X
NY0139181225100000X
NY0165431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q23041Medicare PIN