1558941328 NPI number — BODY HACK HIGH PERFORMANCE PT PLLC

Table of content: (NPI 1558941328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558941328 NPI number — BODY HACK HIGH PERFORMANCE PT PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BODY HACK HIGH PERFORMANCE PT PLLC
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:
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:
1558941328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9972 66TH RD APT 1T
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REGO PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11374-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-733-3795
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1042 JACKSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11101-5819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-433-9909
Provider Business Practice Location Address Fax Number:
718-433-9676
Provider Enumeration Date:
04/14/2021

Additional Information

Authorized Official

Authorized Official Last Name:
ZORRILLA
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
HUMBERTO
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
646-238-3090

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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