Provider Demographics
NPI:1063517944
Name:MORRIS PARK PHYSICAL THERAPY SERVICES PC
Entity type:Organization
Organization Name:MORRIS PARK PHYSICAL THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIGSAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-618-0268
Mailing Address - Street 1:390 JAMES WOODS CT
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1463
Mailing Address - Country:US
Mailing Address - Phone:201-261-0905
Mailing Address - Fax:201-483-8554
Practice Address - Street 1:1215 STRATFORD AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2501
Practice Address - Country:US
Practice Address - Phone:718-618-0268
Practice Address - Fax:718-618-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459589Medicaid
NY02459589Medicaid