1629195391 NPI number — PALISADES PHYSICAL THERAPY PLLC

Table of content: (NPI 1629195391)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629195391 NPI number — PALISADES PHYSICAL THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALISADES 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:
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:
1629195391
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SCOTTI AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALISADES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10964-1319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-359-3950
Provider Business Mailing Address Fax Number:
845-359-3950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SCOTTI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALISADES
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10964-1319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-359-3950
Provider Business Practice Location Address Fax Number:
845-359-3950
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KALOTKIN
Authorized Official First Name:
EDMUND
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
845-359-3950

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  24559 , 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: 120-7330 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q30N31 . This is a "EMPIRE BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 238-4959 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 740-4779 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0300150 . This is a "US FAMILY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0300150 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: SEIU-133-207 . This is a "1199 SEIU" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com