1477503779 NPI number — HEALING TOUCH PHYSICAL THERAPY & REHABILITATION P C

Table of content: (NPI 1477503779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477503779 NPI number — HEALING TOUCH PHYSICAL THERAPY & REHABILITATION P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING TOUCH PHYSICAL THERAPY & REHABILITATION P C
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:
1477503779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 HILLSIDE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11040-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-616-0942
Provider Business Mailing Address Fax Number:
516-616-0943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 HILLSIDE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-616-0942
Provider Business Practice Location Address Fax Number:
516-616-0943
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PERUVINGAL
Authorized Official First Name:
JEDHEESH
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
516-616-0942

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  018928 , 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: 204447P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11239528 . This is a "CAQH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 64501 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6604549 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7195795 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02198447 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 225645 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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