Basic Information
| Provider Information | |||||||||
| NPI: | 1730510041 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ETTINGER | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1536 3RD AVE | ||||||||
| Address2: | 5TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100282167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128612630 | ||||||||
| FaxNumber: | 2128612685 | ||||||||
| Practice Location | |||||||||
| Address1: | 461 PARK AVE S | ||||||||
| Address2: | SUITE 802 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100166822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2126962727 | ||||||||
| FaxNumber: | 2126964499 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2013 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 036974 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.