1063454577 NPI number — SPEAR PHYSICAL AND OCCUPATIONAL THERAPY, LLC

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 1063454577 NPI number — SPEAR PHYSICAL AND OCCUPATIONAL THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEAR PHYSICAL AND OCCUPATIONAL THERAPY, LLC
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:
1063454577
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 5TH AVENUE
Provider Second Line Business Mailing Address:
6TH FL
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-759-2282
Provider Business Mailing Address Fax Number:
212-379-2123

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 E 56TH ST
Provider Second Line Business Practice Location Address:
SUITE 1010
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10022-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-759-2211
Provider Business Practice Location Address Fax Number:
212-829-1189
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROOTENBERG
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-759-2211

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  017761-1 , 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: P1540441 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 32101 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: BCBS - Q5W3A1 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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