1073996534 NPI number — GREEN PHYSICAL THERAPY P.C.

Table of content: DR. JOHN BURLEY COTTER MD (NPI 1124021746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073996534 NPI number — GREEN PHYSICAL THERAPY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN 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:
1073996534
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10111 101ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OZONE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11416-2612
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-845-8325
Provider Business Mailing Address Fax Number:
866-463-6125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10111 101ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OZONE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11416-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-845-8325
Provider Business Practice Location Address Fax Number:
866-463-6125
Provider Enumeration Date:
07/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
YOUNG MI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-845-8325

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  028079 , 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)





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