1295831261 NPI number — PELVIC MUSCLE PHYSICAL THERAPY, PC

Table of content: (NPI 1295831261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295831261 NPI number — PELVIC MUSCLE PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PELVIC MUSCLE PHYSICAL THERAPY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295831261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
34 BACON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11568-1503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-367-6069
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 OLD COUNTRY ROAD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
MINEOLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11501-4198
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-367-6069
Provider Business Practice Location Address Fax Number:
516-876-9607
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
DANIELA
Authorized Official Middle Name:
GUTTA SONDHEIMER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-367-6069

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  002673-01 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 811010 . This is a "ACN, UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A523322 . This is a "OSFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 811010 . This is a "MANAGED PHYSICAL NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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