Basic Information
| Provider Information | |||||||||
| NPI: | 1750828547 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EAST & WEST PHYSICAL THERAPIST & ACUPUNCTURE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 ELIZABETH ST | ||||||||
| Address2: | STE 303 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100134729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122198987 | ||||||||
| FaxNumber: | 2122198982 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 56TH ST | ||||||||
| Address2: | #1 FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112204196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188718899 | ||||||||
| FaxNumber: | 7188718898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2017 | ||||||||
| LastUpdateDate: | 01/31/2017 | ||||||||
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| AuthorizedOfficialLastName: | STANISLAWSKI | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3474197601 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 02227681 | 05 | NY | MEDICAID |