1346285194 NPI number — SOARING EAGLE PHYSICAL THERAPY PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346285194 NPI number — SOARING EAGLE PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOARING EAGLE 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:
1346285194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26 FIREMENS MEMORIAL DR
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10970-3553
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-750-8616
Provider Business Mailing Address Fax Number:
845-362-8474

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2051 BALDWIN RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
YORKTOWN HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10598-4047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-750-8616
Provider Business Practice Location Address Fax Number:
845-362-8474
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FERREIRA
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
914-302-2190

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  0235271 , 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)





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