1679296461 NPI number — DANIELLE AILEEN DENCH PTA

Table of content: DANIELLE AILEEN DENCH PTA (NPI 1679296461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679296461 NPI number — DANIELLE AILEEN DENCH PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENCH
Provider First Name:
DANIELLE
Provider Middle Name:
AILEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDSON
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
AILEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679296461
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 WESLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTER MORICHES
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11934-3718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-495-5354
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NEW YORK THERAPY PLACEMENT SERVICES, INC.
Provider Second Line Business Practice Location Address:
299 HALLOCK AVENUE
Provider Business Practice Location Address City Name:
PORT JEFFERSON STATION
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-331-2204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  1774345 , 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: 1774345 . This is a "PHYSICAL THERAPIST ASSISTANT LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".