1174265110 NPI number — DAWN CHIMENTO PHYSICAL THERAPY, PC

Table of content: (NPI 1174265110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174265110 NPI number — DAWN CHIMENTO PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAWN CHIMENTO PHYSICAL THERAPY, 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:
1174265110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16059 19TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITESTONE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11357-3336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-791-2391
Provider Business Mailing Address Fax Number:
844-791-7187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2455 FRANCIS LEWIS BLVD FL 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITESTONE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11357-4056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-791-2391
Provider Business Practice Location Address Fax Number:
844-791-7187
Provider Enumeration Date:
04/11/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CHIMENTO
Authorized Official First Name:
DAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
718-791-2391

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com