Basic Information
| Provider Information | |||||||||
| NPI: | 1124277611 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MISCH | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.P.T | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 EARLE OVINGTON BLVD | ||||||||
| Address2: | SUITE 225 | ||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115533610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5163212400 | ||||||||
| FaxNumber: | 5163212424 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 BROAD ST | ||||||||
| Address2: | 12TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100042304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125878606 | ||||||||
| FaxNumber: | 2125879024 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 07/30/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 028066 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.