1770622854 NPI number — ISLAND PHYSICAL THERAPY OF RIVERHEAD

Table of content: (NPI 1770622854)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770622854 NPI number — ISLAND PHYSICAL THERAPY OF RIVERHEAD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ISLAND PHYSICAL THERAPY OF RIVERHEAD
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:
1770622854
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 OLD COUNTRY RD
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
RIVERHEAD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-208-4443
Provider Business Mailing Address Fax Number:
631-208-4448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 OLD COUNTRY RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
RIVERHEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-208-4443
Provider Business Practice Location Address Fax Number:
631-208-4448
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARRY
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CO OWNER PRESIDENT
Authorized Official Telephone Number:
631-208-4443

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q07B0 . This is a "EMPIRE CATHERINE BARRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 801067 . This is a "EMPIRE GOVT J SCALAMANDRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: QL8661 . This is a "EMPIRE JOHN SCALAMANDRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 126269 . This is a "VYTRA VINCENT BARRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: QM5151 . This is a "EMPIRE VINCENT BARRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 801062 . This is a "EMPIRE GOVT C BARRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 818365 . This is a "EMPIRE GOVT V BARRY" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com