Provider Demographics
NPI:1861073132
Name:OUTSTANDING PT PC
Entity type:Organization
Organization Name:OUTSTANDING PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BONIFACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:OBER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-361-8420
Mailing Address - Street 1:8374 TALBOT ST APT 1E
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3543
Mailing Address - Country:US
Mailing Address - Phone:646-361-8420
Mailing Address - Fax:
Practice Address - Street 1:5718 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3415
Practice Address - Country:US
Practice Address - Phone:646-361-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy