| NPI | 1679748974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARINA PROSALOVA Billing Manager 718-772-0461 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 018421-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 020098-1) |
| 225100000X Physical Therapist (Licence: NY 028369) | |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2021-01-12 |