Organization
FRESH POND PHYSICAL THERAPY, P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNY TAN (BILLING & COLLECTION DEPT. HEAD)
(718) 456-2543
Entity
Organization
Contact information
Practice address
6805 FRESH POND RD, RIDGEWOOD, NY 11385-5200
(718) 456-2545
(718) 559-6784
Mailing address
68-05 FRESH POND ROAD, RIDGEWOOD, NY 11385
(718) 456-2545
(718) 559-6784
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
015401
NY
2251C2600X
Cardiopulmonary Physical Therapist
—
—
2251E1300X
Clinical Electrophysiology Physical Therapist
—
—
2251G0304X
Geriatric Physical Therapist
—
—
2251H1200X
Hand Physical Therapist
—
—
2251H1300X
Human Factors Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
2251X0800X
Orthopedic Physical Therapist
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
015401
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02184710
—
NY
01
—
19447P
HIP
NY
01
—
4C7780
HEALTHNET
NY
01
—
P2666818
OXFORD
NY
01
—
QQ1073
EMPIRE BC/BS
NY
Enumeration date
01/04/2006
Last updated
05/20/2016
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