1437399425 NPI number — LOTUS PHYSICAL THERAPY FOR WOMEN, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437399425 NPI number — LOTUS PHYSICAL THERAPY FOR WOMEN, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOTUS PHYSICAL THERAPY FOR WOMEN, 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:
1437399425
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
667 S MOUNTAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10956-5709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-282-5532
Provider Business Mailing Address Fax Number:
845-634-2402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 SHAD ROW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIERMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10968-3001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-282-5532
Provider Business Practice Location Address Fax Number:
845-634-2402
Provider Enumeration Date:
03/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
STAROSTIAK
Authorized Official First Name:
LUBA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICAL THERAPIST/MEMBER
Authorized Official Telephone Number:
914-282-5532

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  0125481 , 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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