1558349779 NPI number — DR. JOHN P CVITKOVIC PA-C, PT, C.PED, CFO

Table of content: DR. JOHN P CVITKOVIC PA-C, PT, C.PED, CFO (NPI 1558349779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558349779 NPI number — DR. JOHN P CVITKOVIC PA-C, PT, C.PED, CFO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CVITKOVIC
Provider First Name:
JOHN
Provider Middle Name:
P
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C, PT, C.PED, CFO
Provider Gender Code:
M

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:
1558349779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
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
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:
914-961-1600
Provider Business Mailing Address Fax Number:
888-270-4616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
7TH FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-7606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-961-1600
Provider Business Practice Location Address Fax Number:
888-270-4616
Provider Enumeration Date:
01/06/2006

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: 225000000X , with the licence number:  CFO02565 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224L00000X , with the licence number: CPED1198 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 019369 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 008387 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 222Z00000X , 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: 0000180974616 . This is a "OPTUM HEALTH PHYSICAL THERAPY-UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0401995 . This is a "AETNA- LOCAL 1199/ORTHONET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "POMCO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 616130500 . This is a "FECA/ OFFICE OF FEDERAL WORKERS COMPENSATION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "MAGNACARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P4162456 . This is a "OPTUM HEALTH PHYSICAL THERAPY- OXFORD HEALTH PLAN-FREEDOM/LIBERTY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q622E1 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11556837 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "MULTIPLAN-GEHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "AGEWELL HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3017337 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03021730 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 272438120 . This is a "AMERIGROUP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "VNS CHOICE HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0401995 . This is a "AETNA-ORTHONET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "HUMANA HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 703204 . This is a "OPTUM HEALTH PHYSICAL THERAPY- EMPIRE STATE AND ORANGE COUNTY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0401995 . This is a "CIGNA HEALTHCARE-ORTHONET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "MULTI-PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "AFFINITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com