1386677920 NPI number — PERFORMING ARTS PHYSICAL THERAPY PC

Table of content: (NPI 1386677920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386677920 NPI number — PERFORMING ARTS PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERFORMING ARTS PHYSICAL THERAPY PC
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:
1386677920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 CEDAR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HASTINGS ON HUDSON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10706-3905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-245-7278
Provider Business Mailing Address Fax Number:
212-245-7461

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13 CEDAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS ON HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10706-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-245-7278
Provider Business Practice Location Address Fax Number:
212-245-7461
Provider Enumeration Date:
07/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GALLAGHER
Authorized Official First Name:
SEAN
Authorized Official Middle Name:
PADRIC
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
212-245-7178

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  009366-1 , 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: 12067507 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4261314 . This is a "CIGNA PPO PAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 77A0121 . This is a "ABC HEALTHPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q63523 . This is a "EBCBS HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4417349 . This is a "AETNA NON-PAR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0107301 . This is a "HEALTHNET ORTHONET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 08009814NY01 . This is a "ANTHEM HEALTHPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2C0813 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2166797 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com