Basic Information
| Provider Information | |||||||||
| NPI: | 1093788135 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | EAST SIDE SPORTS PHYSICAL THERAPY, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 244 E 84TH ST | ||||||||
| Address2: | 3 FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100282902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125700209 | ||||||||
| FaxNumber: | 2125700197 | ||||||||
| Practice Location | |||||||||
| Address1: | 244 E 84TH ST | ||||||||
| Address2: | 3 FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100282902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125700209 | ||||||||
| FaxNumber: | 2125700197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SARANITI | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2125700209 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 005564 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.