Provider Demographics
NPI:1699871780
Name:LONG ISLAND CITY PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:LONG ISLAND CITY PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR PHYSICAL THERAPY
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRANCALE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:718-943-7100
Mailing Address - Street 1:1043 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5607
Mailing Address - Country:US
Mailing Address - Phone:718-943-7100
Mailing Address - Fax:718-786-9798
Practice Address - Street 1:1043 48TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5607
Practice Address - Country:US
Practice Address - Phone:718-943-7100
Practice Address - Fax:718-786-9798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022838-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11452885OtherCAQH PROVIDER ID
NY6606984Medicare UPIN
NY07150Medicare ID - Type UnspecifiedGROUP GHI MEDICARE NUMBER
NY07150GMedicare ID - Type UnspecifiedGHI MEDICARE INDIVIDUAL