1467457820 NPI number — SHERRIE GLASSER PHYSICAL THERAPY JOHN DOUGLAS PHYSICAL THERAPIST ASST

Table of content: (NPI 1467457820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467457820 NPI number — SHERRIE GLASSER PHYSICAL THERAPY JOHN DOUGLAS PHYSICAL THERAPIST ASST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHERRIE GLASSER PHYSICAL THERAPY JOHN DOUGLAS PHYSICAL THERAPIST ASST
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:
1467457820
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:
256 N WELLWOOD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINDENHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11757-3707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-957-7300
Provider Business Mailing Address Fax Number:
631-957-7024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
256 N WELLWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINDENHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11757-3707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-957-7300
Provider Business Practice Location Address Fax Number:
631-957-7024
Provider Enumeration Date:
06/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GLASSER
Authorized Official First Name:
SHERRIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST DIRECTOR
Authorized Official Telephone Number:
516-745-8050

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27301 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 40839P . This is a "HIP/HEALTHCARE PARTNERS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QL0411 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3422589 . This is a "US HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: ANC1349 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0141163 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 76643 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AZ00688 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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