Basic Information
| Provider Information | |||||||||
| NPI: | 1407185341 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAYSIDE PHYSICAL THERAPY, CHIROPRACTIC & ACUPUNCTURE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 604795 | ||||||||
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| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113604795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007508616 | ||||||||
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| Practice Location | |||||||||
| Address1: | 21315 33RD RD | ||||||||
| Address2: | |||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113611508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007508616 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2009 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| AuthorizedOfficialLastName: | LEFCORT | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8453628400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081S0010X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine |
No ID Information.