1548382831 NPI number — STATION PHYSICAL THERAPY

Table of content: (NPI 1548382831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548382831 NPI number — STATION PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STATION 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:
1548382831
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:
10 E 33RD STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-487-2495
Provider Business Mailing Address Fax Number:
646-487-2497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 E 33RD STREET
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-487-2495
Provider Business Practice Location Address Fax Number:
646-487-2497
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HENAO
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
ANGELIQUE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
646-487-2495

Provider Taxonomy Codes

  • Taxonomy code: 207RS0010X , with the licence number:  0139731 , 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: 186709P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2195022 . This is a "OXFORD HEALTH" identifier . This identifiers is of the category "OTHER".




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