1417061896 NPI number — RIVERDALE SPORTS PHYSICAL THERAPY PC

Table of content: (NPI 1417061896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417061896 NPI number — RIVERDALE SPORTS PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RIVERDALE SPORTS 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:
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:
1417061896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32-65 JOHNSON AVE
Provider Second Line Business Mailing Address:
LOWER LEVEL
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-432-1323
Provider Business Mailing Address Fax Number:
718-432-1326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32-65 JOHNSON AVE
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-432-1323
Provider Business Practice Location Address Fax Number:
718-432-1326
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHERMAN
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
718-432-1323

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  022885-1 , 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: 6401310 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 209968P . This is a "HIP PRIS#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6698279 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 839609 . This is a "MPN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180057 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2581814 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100040667 . This is a "AFFINITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 022885 S . This is a "HORIZON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2068 . This is a "MAGNACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7068699 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: QP7403 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P3600980 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".




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