Provider Demographics
NPI:1528277704
Name:BIALSTOCK, FARICA TERRY (PT)
Entity type:Individual
Prefix:PROF
First Name:FARICA
Middle Name:TERRY
Last Name:BIALSTOCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 JEROLD ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3712
Mailing Address - Country:US
Mailing Address - Phone:516-572-7552
Mailing Address - Fax:516-572-7565
Practice Address - Street 1:1 EDUCATION DR
Practice Address - Street 2:NASSAU COMMUNITY COLLEGE
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-6719
Practice Address - Country:US
Practice Address - Phone:516-572-7552
Practice Address - Fax:516-572-7565
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 005769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist