1134595895 NPI number — MOUNT JOY PHYSICAL THERAPY, P.C.

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 1134595895 NPI number — MOUNT JOY PHYSICAL THERAPY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT JOY PHYSICAL THERAPY, P.C.
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:
1134595895
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
312 LONG BEACH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ISLAND PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11558-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-447-6666
Provider Business Mailing Address Fax Number:
516-447-6667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
312 LONG BEACH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ISLAND PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11558-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-447-6666
Provider Business Practice Location Address Fax Number:
516-447-6667
Provider Enumeration Date:
08/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LUBIN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
516-447-6666

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , 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)





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