Provider Demographics
NPI:1598304875
Name:BLACK, DENISE C
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:C
Last Name:BLACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5063
Mailing Address - Country:US
Mailing Address - Phone:914-723-1642
Mailing Address - Fax:914-723-1563
Practice Address - Street 1:700 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5063
Practice Address - Country:US
Practice Address - Phone:914-723-1642
Practice Address - Fax:914-723-1563
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist