1346323813 NPI number — SOUTHAMPTON HOSPITAL/SPORTS REHAB WH

Table of content: ELAINE P. WHITTAKER M.D. (NPI 1285675280)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346323813 NPI number — SOUTHAMPTON HOSPITAL/SPORTS REHAB WH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHAMPTON HOSPITAL/SPORTS REHAB WH
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:
6
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:
1346323813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 OLD RIVERHEAD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTHAMPTON BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11978-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-288-7767
Provider Business Mailing Address Fax Number:
631-288-7100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 OLD RIVERHEAD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTHAMPTON BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-288-7767
Provider Business Practice Location Address Fax Number:
631-288-7100
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH-BARTON
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST/SITE LEADER
Authorized Official Telephone Number:
631-288-7767

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004540-1 , 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: 022570 . This is a "HIP-PETER FISCINA, P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QH5051 . This is a "BC-BS-EILEEN SOLJANICH,PT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QH5392 . This is a "BCBS-TONI WORMOLD,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2365871 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698019 . This is a "GHI-EILEEN SOLJANICH,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 018611 . This is a "HIP-TONI WORMOLD, P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 32803 . This is a "US FAMILY HEALTH-SPORTS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698017 . This is a "GHI-CHRISTINE SMITHBARTON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AZ00175 . This is a "MDNY-" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 015752-A64 . This is a "HEALTHFIRST-E.S.,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 32803 . This is a "CIGNA-SPORTS REHAB WH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698021 . This is a "GHI-PETER M. FISCINA, P.T" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00274406 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: QN0681 . This is a "BCBS-PETER FISCINA,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58418 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698016 . This is a "GHI-TONI L. WORMOLD,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QH5061 . This is a "BCBS CHRISTINESMITHBARTON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698018 . This is a "GHI-STEVE ZACHARSKI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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