Organization
DEPARTMENT OF EDUCATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PHYLLIS ANN FORMAN (PHYSICAL THERAPIST)
(718) 556-1820
Entity
Organization
Contact information
Practice address
155 TOMPKINS AVE, STATEN ISLAND, NY 10304-2601
(718) 556-1820
Mailing address
155 TOMPKINS AVE, STATEN ISLAND, NY 10304-2601
(718) 556-1820
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
021206-1
NY
Other
Enumeration date
03/26/2012
Last updated
03/26/2012
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