1174849756 NPI number — MRS. GAIL LUCILLE NISTICO PHYSICAL THERAPY ASS

Table of content: MRS. GAIL LUCILLE NISTICO PHYSICAL THERAPY ASS (NPI 1174849756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174849756 NPI number — MRS. GAIL LUCILLE NISTICO PHYSICAL THERAPY ASS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NISTICO
Provider First Name:
GAIL
Provider Middle Name:
LUCILLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPY ASS
Provider Gender Code:
F

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:
1174849756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 SEMINARY RD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALLICOON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12723-5316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-887-1956
Provider Business Mailing Address Fax Number:
845-887-1956

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
256 SUNSET LAKE RD
Provider Second Line Business Practice Location Address:
SULLIVAN COUNTY ADULT CARE CENTER
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-292-5910
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  000169-1 , 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)