Provider Demographics
NPI:1205959731
Name:ORTHOPEDIC SPORTS PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:ORTHOPEDIC SPORTS PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:ROCHELLE
Authorized Official - Last Name:KIRSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-499-0224
Mailing Address - Street 1:333 E 53RD ST
Mailing Address - Street 2:# 6 E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4911
Mailing Address - Country:US
Mailing Address - Phone:917-533-4700
Mailing Address - Fax:212-986-2757
Practice Address - Street 1:275 MADISON AVE
Practice Address - Street 2:SUITE 2400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1101
Practice Address - Country:US
Practice Address - Phone:212-370-5544
Practice Address - Fax:212-986-2757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ10211Medicare ID - Type Unspecified