1194021709 NPI number — MRS. ALMA CONCEPCION BARGAMENTO PHYSICAL THERAPIST

Table of content: MRS. ALMA CONCEPCION BARGAMENTO PHYSICAL THERAPIST (NPI 1194021709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194021709 NPI number — MRS. ALMA CONCEPCION BARGAMENTO PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARGAMENTO
Provider First Name:
ALMA
Provider Middle Name:
CONCEPCION
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
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:
1194021709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 GROVE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMINGDALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07403-1607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-626-1777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
465 GRAND STREET
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-1999
Provider Business Practice Location Address Fax Number:
212-420-1910
Provider Enumeration Date:
01/28/2011

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: 225100000X , with the licence number:  022536-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 40QA01155000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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