1013549807 NPI number — TWENTYSEVENEASTPHYSIOTHERAPY PC

Table of content: DR. NICHOLAS SIMMS MOORE MD (NPI 1093339491)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013549807 NPI number — TWENTYSEVENEASTPHYSIOTHERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TWENTYSEVENEASTPHYSIOTHERAPY 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:
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:
1013549807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POB 2333
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAG HARBOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11963
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-919-5189
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
34 BAY STREET
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
SAG HARBOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-919-5189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2020

Additional Information

Authorized Official

Authorized Official Last Name:
FITZGIBBON
Authorized Official First Name:
SINEAD
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER, PARTNER
Authorized Official Telephone Number:
631-484-5416

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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