Provider Demographics
NPI:1962780031
Name:HEALTHPRO PHYSICAL THERAPY OF NEW YORK, PC
Entity type:Organization
Organization Name:HEALTHPRO PHYSICAL THERAPY OF NEW YORK, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-270-2518
Mailing Address - Street 1:222 LOUIS AVE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3523
Mailing Address - Country:US
Mailing Address - Phone:516-270-2518
Mailing Address - Fax:
Practice Address - Street 1:222 LOUIS AVE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3523
Practice Address - Country:US
Practice Address - Phone:516-270-2518
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-23
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020759-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy