Basic Information
| Provider Information | |||||||||
| NPI: | 1053046011 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARSUTA | ||||||||
| FirstName: | CHARLES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8746 20TH AVE # L | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112144802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186480888 | ||||||||
| FaxNumber: | 8559553899 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 GRAHAM AVE FL 2 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112063656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186480888 | ||||||||
| FaxNumber: | 8559553899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2022 | ||||||||
| LastUpdateDate: | 07/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.