1003155938 NPI number — ORTHO KINETICS OF NEW YORK INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003155938 NPI number — ORTHO KINETICS OF NEW YORK INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHO KINETICS OF NEW YORK INC
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:
1003155938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 DUFFY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11801-3640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-484-0897
Provider Business Mailing Address Fax Number:
516-470-1820

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 DUFFY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11801-3640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-513-1274
Provider Business Practice Location Address Fax Number:
516-470-1820
Provider Enumeration Date:
02/13/2013

Additional Information

Authorized Official

Authorized Official Last Name:
GUARINO
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
AGENT PRINCIPLE
Authorized Official Telephone Number:
516-513-1274

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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