Provider Demographics
NPI:1033950092
Name:NEW BROADWAY PHYSICAL THERAPY
Entity type:Organization
Organization Name:NEW BROADWAY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:SANGWON
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:646-240-8453
Mailing Address - Street 1:280 BROADWAY STE 3
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8278
Mailing Address - Country:US
Mailing Address - Phone:845-561-3214
Mailing Address - Fax:845-565-0319
Practice Address - Street 1:280 BROADWAY STE 3
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-8278
Practice Address - Country:US
Practice Address - Phone:845-561-3214
Practice Address - Fax:845-565-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty