1265412381 NPI number — MR. JACEK GOLIS MS PT

Table of content: MR. JACEK GOLIS MS PT (NPI 1265412381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265412381 NPI number — MR. JACEK GOLIS MS PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLIS
Provider First Name:
JACEK
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS PT
Provider Gender Code:
M

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:
1265412381
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 WASHINGTON AVENUE
Provider Second Line Business Mailing Address:
PLEASANTVILLE PHYSICAL THERAPY & SPORTS CARE PC
Provider Business Mailing Address City Name:
PLEASANTVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-741-2767
Provider Business Mailing Address Fax Number:
914-741-2776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 WASHINGTON AVENUE
Provider Second Line Business Practice Location Address:
PLEASANTVILLE PHYSICAL THERAPY & SPORTS CARE PC
Provider Business Practice Location Address City Name:
PLEASANTVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-741-2767
Provider Business Practice Location Address Fax Number:
914-741-2776
Provider Enumeration Date:
01/17/2006

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:  025552 , 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: 0222701 . This is a "ORTHONET CIGNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0222701 . This is a "ORTHONET USFH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1177828 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0013701 . This is a "ORTHONET AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q34B8 . This is a "EMPIRE BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0222701 . This is a "ORTHONET HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7022766 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0764866 . This is a "CIGNA PPO" identifier . This identifiers is of the category "OTHER".




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