Provider Demographics
NPI:1992254585
Name:MAURIZIO A LLIN PT PC
Entity type:Organization
Organization Name:MAURIZIO A LLIN PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:MAURIZIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:LLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-710-1413
Mailing Address - Street 1:4029 168TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-2630
Mailing Address - Country:US
Mailing Address - Phone:917-710-1413
Mailing Address - Fax:
Practice Address - Street 1:4029 168TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2630
Practice Address - Country:US
Practice Address - Phone:917-710-1413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0378862251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty