1922159359 NPI number — PERFORM PHYSICAL THERAPY AND PILATES PLLC

Table of content: (NPI 1922159359)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922159359 NPI number — PERFORM PHYSICAL THERAPY AND PILATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORM PHYSICAL THERAPY AND PILATES 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:
1922159359
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
141 LIDO BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIDO BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11561-4833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-220-4177
Provider Business Mailing Address Fax Number:
516-992-2282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
141 LIDO BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIDO BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-4833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-220-4177
Provider Business Practice Location Address Fax Number:
516-992-2282
Provider Enumeration Date:
01/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STOSKI
Authorized Official First Name:
MELINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
516-220-4177

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  013055 , 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: 803355 . This is a "MPN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1495973 . This is a "CIGNA PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q35E42 . This is a "BCBS PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0024301 . This is a "ORTHONET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11303 . This is a "MAGNACARE PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1174577217 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0123036 . This is a "GHI PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6C5374 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 133998 . This is a "VYTRA PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 107959P . This is a "HIP PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2607498 . This is a "UHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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