Provider Demographics
NPI:1457176190
Name:FORM FITNESS AND THERAPEUTICS INC
Entity type:Organization
Organization Name:FORM FITNESS AND THERAPEUTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOORAIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:929-360-7861
Mailing Address - Street 1:290 BATTLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-1503
Mailing Address - Country:US
Mailing Address - Phone:929-360-7861
Mailing Address - Fax:
Practice Address - Street 1:290 BATTLE AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10606-1503
Practice Address - Country:US
Practice Address - Phone:929-360-7861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty