NPI # 

Practice Address:

25 Fanning St

Staten Island, NY, 10314-5307

Practice Phone:

718-698-2475

License Number:

039429

License State:

NY

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Physical Therapy

Taxonomy Code:

261QP2000X