1669576054 NPI number — CATSKILL MOUNTAIN PHYSICAL THERAPY P.C.

Table of content: (NPI 1669576054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669576054 NPI number — CATSKILL MOUNTAIN PHYSICAL THERAPY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATSKILL MOUNTAIN PHYSICAL THERAPY P.C.
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:
1669576054
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318FOXHOLLOWRD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHANDAKEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12480-0064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-688-7064
Provider Business Mailing Address Fax Number:
845-688-2811

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 MAVERICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENFDORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-688-7064
Provider Business Practice Location Address Fax Number:
845-688-2811
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
845-688-7064

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  014531-1 , 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: 603426 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: Q16R71 . This is a "EMPIRE BLUE CROSS BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10096311 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1770507469 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 89756 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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