Organization
OUTSTANDING PT PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BONIFACIO OBER PT (PRESIDENT)
(646) 361-8420
Entity
Organization
Contact information
Practice address
5718 WOODSIDE AVE, WOODSIDE, NY 11377-3415
(646) 361-8420
Mailing address
8374 TALBOT ST APT 1E, KEW GARDENS, NY 11415-3543
(646) 361-8420
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
04/19/2021
Last updated
04/19/2021
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