1104903467 NPI number — AR PHYSICAL THERAPY & PHYSICAL THERAPIST ASSISTANT PLLC

Table of content: (NPI 1104903467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104903467 NPI number — AR PHYSICAL THERAPY & PHYSICAL THERAPIST ASSISTANT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AR PHYSICAL THERAPY & PHYSICAL THERAPIST ASSISTANT 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:
ABSOLUTE 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:
1104903467
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:
19 E 37TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-684-6699
Provider Business Mailing Address Fax Number:
212-684-1886

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 E 37TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-684-6699
Provider Business Practice Location Address Fax Number:
212-684-1886
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PENNELLA
Authorized Official First Name:
ARMANDO
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-684-6699

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  023690-1 , 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: 12276750 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 248-3115 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P3553077 . This is a "OXFORD OUT-OF-NETWORK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00000102912 . This is a "BETTER HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4584486 . This is a "PPNI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6606597 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5590367 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com