1194826651 NPI number — WADING RIVER PHYSICAL THERAPY, PC

Table of content: (NPI 1194826651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194826651 NPI number — WADING RIVER PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WADING RIVER 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:
1194826651
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5958 ROUTE 25A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WADING RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11792-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-929-8200
Provider Business Mailing Address Fax Number:
631-929-8228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5958 ROUTE 25A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADING RIVER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11792-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-929-8200
Provider Business Practice Location Address Fax Number:
631-929-8228
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VANCURA
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
631-929-8200

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: N78062 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2N5211 . This is a "CHILD HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com