1952511701 NPI number — REHABILITATION AND PHYSICAL THERAPY CONSULTANT PC

Table of content: (NPI 1952511701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952511701 NPI number — REHABILITATION AND PHYSICAL THERAPY CONSULTANT PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REHABILITATION AND PHYSICAL THERAPY CONSULTANT PC
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:
1952511701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
724 E 18TH ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11230-1801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
347-249-6501
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1641 BERGEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11213-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-249-6501
Provider Business Practice Location Address Fax Number:
718-778-3083
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OKOME
Authorized Official First Name:
MUOYO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT AND CLINICAL DIRECTOR
Authorized Official Telephone Number:
347-249-6501

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  8361-1 , 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: AS 203 . This is a "OXFORD PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5714653 . This is a "FIRST HEALTH INS PROV #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 77151 . This is a "CAREPLUS PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: PRIS #20304P . This is a "HIP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0038950103 . This is a "HEALTHPLUS PROVIDERE #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1841263423 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2326173 . This is a "AETNA PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6699117 . This is a "GHI PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 815353 . This is a "ACN GROUP PROVIDER #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 008361S . This is a "HEATHCARE PARTNERS PRVD #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00869397-001 . This is a "UNITED HEALTHCARE ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 008361NY . This is a "1199SEIU PROVIDER ID #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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