1396779179 NPI number — BAYONNE PHYSICAL THERAPY INC

Table of content: (NPI 1396779179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396779179 NPI number — BAYONNE PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAYONNE PHYSICAL THERAPY INC
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:
1396779179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5263 GOLDEN GATE PKWY
Provider Second Line Business Mailing Address:
UNITE E
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34116-7601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-352-9884
Provider Business Mailing Address Fax Number:
239-352-8610

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 BONITA BEACH ROAD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BONITA SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34135-4277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-949-9599
Provider Business Practice Location Address Fax Number:
239-947-9347
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORTESE
Authorized Official First Name:
DIANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
239-352-9884

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  042638 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CG7750 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: Y908C . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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