1285090050 NPI number — PROCORE PHYSICAL THERAPY P.C.

Table of content: CRYSTAL ANN CHEROMIAH LCSW (NPI 1841868148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285090050 NPI number — PROCORE PHYSICAL THERAPY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROCORE PHYSICAL THERAPY P.C.
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:
1285090050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N MIDDLETOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEARL RIVER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10965-2017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-589-0556
Provider Business Mailing Address Fax Number:
845-589-0558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N MIDDLETOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEARL RIVER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10965-2017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-589-0556
Provider Business Practice Location Address Fax Number:
845-589-0558
Provider Enumeration Date:
01/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
STEMKOWSKI
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/PT
Authorized Official Telephone Number:
845-589-0556

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  0185251 , 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: Q2W2C1 . This is a "MEDICARE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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