1487786158 NPI number — STEVEN C. DESOUSA, PT, PC

Table of content: (NPI 1487786158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487786158 NPI number — STEVEN C. DESOUSA, PT, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEVEN C. DESOUSA, PT, 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:
EAST NORTHPORT PHYSICAL THERAPY
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:
1487786158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
554 LARKFIELD RD
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
EAST NORTHPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11731-4205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-266-4501
Provider Business Mailing Address Fax Number:
631-266-4502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
554 LARKFIELD RD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
EAST NORTHPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11731-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-266-4501
Provider Business Practice Location Address Fax Number:
631-266-4502
Provider Enumeration Date:
03/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DESOUSA
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
631-757-1791

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  018783-0 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 013896-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251C2600X , with the licence number: 013896-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251E1200X , with the licence number: 013896-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251G0304X , with the licence number: 013896-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251G0304X , with the licence number: 018783-0 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251H1200X , with the licence number: 013896-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251N0400X , with the licence number: 013896-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , with the licence number: 013896-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X , with the licence number: 013896-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 002632-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 54388 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q38811 . This is a "EMPIRE BC BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AZ00899 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6699926 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A2517039 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01914598 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 218199P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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