Provider Demographics
NPI:1457710642
Name:COSMOPOLITAN PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:COSMOPOLITAN PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHERWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PALLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:347-255-7063
Mailing Address - Street 1:3258 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-4356
Mailing Address - Country:US
Mailing Address - Phone:347-255-7063
Mailing Address - Fax:347-255-7063
Practice Address - Street 1:13630 MAPLE AVE STE 2G
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3867
Practice Address - Country:US
Practice Address - Phone:347-368-6799
Practice Address - Fax:888-807-5211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031641225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03397784Medicaid