Provider Demographics
NPI:1447684774
Name:CORNERSTONE PHYSICAL THERAPY
Entity type:Organization
Organization Name:CORNERSTONE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSEOK
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-750-7722
Mailing Address - Street 1:115 W 30TH STREET
Mailing Address - Street 2:500B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001
Mailing Address - Country:US
Mailing Address - Phone:212-764-3924
Mailing Address - Fax:
Practice Address - Street 1:115 W 30TH ST
Practice Address - Street 2:500B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4010
Practice Address - Country:US
Practice Address - Phone:212-764-3924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024040225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty