1104012640 NPI number — ACCESS PHYSICAL THERAPY

Table of content: (NPI 1104012640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104012640 NPI number — ACCESS PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS PHYSICAL THERAPY
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:
1104012640
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3299
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14240-3299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-284-4474
Provider Business Mailing Address Fax Number:
716-284-4484

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2316 PINE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14301-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-284-4474
Provider Business Practice Location Address Fax Number:
716-284-4484
Provider Enumeration Date:
09/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FROSOLONE
Authorized Official First Name:
ENRICO
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
716-284-4474

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  010913-1 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 017075-1 ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 025797 , 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: 000628316001 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9313114 . This is a "IHA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03138341 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02726447 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00052890002 . This is a "BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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