1417185018 NPI number — DR. VITA M DEQUATRO DOCTORATE OF PT

Table of content: DR. VITA M DEQUATRO DOCTORATE OF PT (NPI 1417185018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417185018 NPI number — DR. VITA M DEQUATRO DOCTORATE OF PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEQUATRO
Provider First Name:
VITA
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DOCTORATE OF PT
Provider Gender Code:
F

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:
1417185018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 MAIN ST
Provider Second Line Business Mailing Address:
SUITE#202 2ND FLOOR
Provider Business Mailing Address City Name:
TUCKAHOE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10707-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-961-1010
Provider Business Mailing Address Fax Number:
914-961-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE#202 2ND FLOOR
Provider Business Practice Location Address City Name:
TUCKAHOE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10707-2948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-961-1010
Provider Business Practice Location Address Fax Number:
914-961-1011
Provider Enumeration Date:
06/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0383371 , 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: PENDING . This is a "AETNA ORHTONET-MCLEAN AVENUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "AETNA LOCAL 1199" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "CIGNA ORHTONET MCLEAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "GEHA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "US FAMILY HEALTH-ORTHONET TUCKAHOE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "US FAMILLY HEALTH-ORTHONET MCLEAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "AMIDACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "FIDELIS HEALHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "POMCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "AFFINITY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "EMBLEM HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "FPN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "MULTIPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "OPTUM PHYSICAL THERAPY/EMPIRE/OXFORD/UHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "MAGNACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "VNS-NYS" identifier . This identifiers is of the category "OTHER".
  • Identifier: PENDING , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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