1578583985 NPI number — NEW YORK PHYSICAL THERAPY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578583985 NPI number — NEW YORK PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW YORK PHYSICAL THERAPY, PLLC
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:
COMPLETE CARE 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:
1578583985
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:
120 NEWHAM AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11717-5624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-813-2143
Provider Business Mailing Address Fax Number:
888-552-6176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 MANETTO HILL RD
Provider Second Line Business Practice Location Address:
SUITE #105A
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-1311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-932-5260
Provider Business Practice Location Address Fax Number:
888-215-5172
Provider Enumeration Date:
07/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREENE
Authorized Official First Name:
CYNDI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGED CARE DIRECTOR
Authorized Official Telephone Number:
631-813-2143

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





Copyright © 2007-2024 www.npivalidator.com