1689175713 NPI number — LK THERAPY PT, OT AND SLP PLLC

Table of content: (NPI 1689175713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689175713 NPI number — LK THERAPY PT, OT AND SLP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LK THERAPY PT, OT AND SLP 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:
1689175713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 COUNTY ROUTE 49
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SLATE HILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10973-3713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-697-5064
Provider Business Mailing Address Fax Number:
845-697-5064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 COUNTY ROUTE 49
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLATE HILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10973-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-697-5064
Provider Business Practice Location Address Fax Number:
845-697-5064
Provider Enumeration Date:
02/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
FORDE
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
845-697-5064

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X , with the licence number: 025596 , 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: 1487021242 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1871961946 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1043625148 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104118462 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1811363393 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326170986 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1720489040 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1922545938 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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