1336225572 NPI number — ADVANCED SPORTS, PHYSICAL & ORTHOPEDIC REHABILITATIVE THERAPY SERVICES

Table of content: (NPI 1336225572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336225572 NPI number — ADVANCED SPORTS, PHYSICAL & ORTHOPEDIC REHABILITATIVE THERAPY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SPORTS, PHYSICAL & ORTHOPEDIC REHABILITATIVE THERAPY SERVICES
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:
ADVANCED S.P.O.R.T.S.
Provider Other Organization Name Type Code:
3
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:
1336225572
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17660 UNION TPKE
Provider Second Line Business Mailing Address:
SUITE 195
Provider Business Mailing Address City Name:
FRESH MEADOWS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11366-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-820-9300
Provider Business Mailing Address Fax Number:
718-820-9382

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17660 UNION TPKE
Provider Second Line Business Practice Location Address:
SUITE 195
Provider Business Practice Location Address City Name:
FRESH MEADOWS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11366-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-820-9300
Provider Business Practice Location Address Fax Number:
718-820-9382
Provider Enumeration Date:
10/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CAPOBIANCO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
718-820-9300

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: N82127 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com