1912237264 NPI number — I-OM PHYSICAL THERAPY P.C

Table of content: KEITH ALEXANDER POOLE LISW (NPI 1487351532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912237264 NPI number — I-OM PHYSICAL THERAPY P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
I-OM PHYSICAL THERAPY 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:
1912237264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 PARK ROW
Provider Second Line Business Mailing Address:
15J
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10038-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-658-0955
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 JOHN ST
Provider Second Line Business Practice Location Address:
SUITE 1445
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10038-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-715-1540
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BUENCONSEJO
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
212-571-4800

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  023922-1 , 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: Q12X23 . This is a "MEDICARE ID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com