Provider Demographics
NPI:1548798671
Name:TORY PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:TORY PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-948-7320
Mailing Address - Street 1:7101 MINUTEMAN LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-6105
Mailing Address - Country:US
Mailing Address - Phone:718-948-7320
Mailing Address - Fax:718-448-8287
Practice Address - Street 1:1330A ROCKLAND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4944
Practice Address - Country:US
Practice Address - Phone:718-619-2259
Practice Address - Fax:718-228-6731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-02
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017990225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty