1306174198 NPI number — NY PHYSICAL THERAPY & WELLNESS BOHEMIA, PLLC

Table of content: MS. COURTNEY WARREN CRITTENDON LCSW (NPI 1144354770)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306174198 NPI number — NY PHYSICAL THERAPY & WELLNESS BOHEMIA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NY PHYSICAL THERAPY & WELLNESS BOHEMIA, 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:
1306174198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CORPORATE DRIVE
Provider Second Line Business Mailing Address:
SUITE GL-1
Provider Business Mailing Address City Name:
BOHEMIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11716-2663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-319-6911
Provider Business Mailing Address Fax Number:
631-319-6909

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CORPORATE DRIVE
Provider Second Line Business Practice Location Address:
SUITE GL-1
Provider Business Practice Location Address City Name:
BOHEMIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11716-2663
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-319-6911
Provider Business Practice Location Address Fax Number:
631-319-6909
Provider Enumeration Date:
12/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER/DIRECTOR
Authorized Official Telephone Number:
631-319-6911

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , 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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