Provider Demographics
NPI:1679780654
Name:ELITE CARE PHYSICAL THERAPY REHAB.P.C.
Entity type:Organization
Organization Name:ELITE CARE PHYSICAL THERAPY REHAB.P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHWEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:PTMS
Authorized Official - Phone:212-927-3422
Mailing Address - Street 1:630 FORT WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3900
Mailing Address - Country:US
Mailing Address - Phone:212-927-3422
Mailing Address - Fax:212-927-9250
Practice Address - Street 1:630 FORT WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-3900
Practice Address - Country:US
Practice Address - Phone:212-927-3422
Practice Address - Fax:212-927-9250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005975-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1891709770OtherINDIVIDUAL NPI NUMBER
NY10764994OtherINDIVIDUAL CAQH NUMBER
NY1750383147OtherINDIVIDUAL NPI NUMBER
NY1801017587OtherINDIVIDUAL NPI NUMBER
NY1750383147OtherINDIVIDUAL NPI NUMBER
NY1801017587OtherINDIVIDUAL NPI NUMBER
NYQ1WEI1Medicare ID - Type UnspecifiedGROUP NUMBER