Provider Demographics
NPI:1730213984
Name:CORE CARE PHYSICAL THERAPY AND ACUPUNCTURE,PLLC
Entity type:Organization
Organization Name:CORE CARE PHYSICAL THERAPY AND ACUPUNCTURE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JIWON
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:201-673-4154
Mailing Address - Street 1:1 PERLMAN DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-5281
Mailing Address - Country:US
Mailing Address - Phone:845-517-3330
Mailing Address - Fax:845-517-3331
Practice Address - Street 1:1 PERLMAN DR
Practice Address - Street 2:SUITE #101
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-5281
Practice Address - Country:US
Practice Address - Phone:845-517-3330
Practice Address - Fax:845-517-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002753-1OtherACUPUNCTURE LICENSE
NY021333-1OtherPHYSICAL THERAPY LICENSE