1346323813 NPI number — SOUTHAMPTON HOSPITAL/SPORTS REHAB WH

Table of content: (NPI 1346323813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346323813 NPI number — SOUTHAMPTON HOSPITAL/SPORTS REHAB WH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHAMPTON HOSPITAL/SPORTS REHAB WH
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:
SPORTS REHAB WH
Provider Other Organization Name Type Code:
3
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:
1346323813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 OLD RIVERHEAD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTHAMPTON BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11978-1401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-288-7767
Provider Business Mailing Address Fax Number:
631-288-7100

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
74 OLD RIVERHEAD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTHAMPTON BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-288-7767
Provider Business Practice Location Address Fax Number:
631-288-7100
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH-BARTON
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST/SITE LEADER
Authorized Official Telephone Number:
631-288-7767

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  004540-1 , 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: 022570 . This is a "HIP-PETER FISCINA, P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QH5051 . This is a "BC-BS-EILEEN SOLJANICH,PT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QH5392 . This is a "BCBS-TONI WORMOLD,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2365871 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698019 . This is a "GHI-EILEEN SOLJANICH,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 018611 . This is a "HIP-TONI WORMOLD, P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 32803 . This is a "US FAMILY HEALTH-SPORTS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698017 . This is a "GHI-CHRISTINE SMITHBARTON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AZ00175 . This is a "MDNY-" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 015752-A64 . This is a "HEALTHFIRST-E.S.,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 32803 . This is a "CIGNA-SPORTS REHAB WH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698021 . This is a "GHI-PETER M. FISCINA, P.T" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00274406 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: QN0681 . This is a "BCBS-PETER FISCINA,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58418 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698016 . This is a "GHI-TONI L. WORMOLD,P.T." identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QH5061 . This is a "BCBS CHRISTINESMITHBARTON" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6698018 . This is a "GHI-STEVE ZACHARSKI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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