Basic Information
| Provider Information | |||||||||
| NPI: | 1154079309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STEP-UP NY PHYSICAL THERAPY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 WOODFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WEST HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115522528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089225762 | ||||||||
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| Practice Location | |||||||||
| Address1: | 245 WOODFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WEST HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115522528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089225762 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2022 | ||||||||
| LastUpdateDate: | 03/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | BORJA | ||||||||
| AuthorizedOfficialFirstName: | NINO POMPEYO ROCCO | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/CEO/PT | ||||||||
| AuthorizedOfficialTelephone: | 9089225762 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
| NPICertificationDate: | 03/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.