1396066320 NPI number — NY SPORTSMED AND PHYSICAL THERAPY

Table of content: JUSTIN BORRAS-REED (NPI 1902143845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396066320 NPI number — NY SPORTSMED AND PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NY SPORTSMED AND PHYSICAL THERAPY
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:
6
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:
1396066320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
11/11/2010
NPI Reactivation Date:
01/07/2011

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 E 48TH ST
Provider Second Line Business Mailing Address:
SUITE 901
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10017-1014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-750-1110
Provider Business Mailing Address Fax Number:
212-750-1170

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1841 BROADWAY
Provider Second Line Business Practice Location Address:
SUITE 1100
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10023-7603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-245-5500
Provider Business Practice Location Address Fax Number:
212-245-5540
Provider Enumeration Date:
06/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BANKS
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
212-750-1110

Provider Taxonomy Codes

  • Taxonomy code: 207RS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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