# EXECUTIVE PARK PT OF BRIARCLIFF LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508102849
- **Authorized official:** MELISA NIELI (BILLING MANAGER)
- **Authorized official phone:** (914) 346-5175

## Contact information

- **Practice address:** 565 N STATE RD, BRIARCLIFF, NY 10510-1523
- **Practice address phone:** (914) 263-3280
- **Mailing address:** 1034 N BROADWAY, YONKERS, NY 10701-1328
- **Mailing address phone:** (914) 509-4640
- **Mailing address fax:** (914) 509-4639

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 023806 | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | 023806 | — | Yes |

## Other

- **Enumeration date:** 12/13/2012
- **Last updated:** 12/13/2012