1679649883 NPI number — SANVIN PHYSICAL THERAPY PC

Table of content: (NPI 1679649883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679649883 NPI number — SANVIN PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANVIN PHYSICAL THERAPY PC
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:
1679649883
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
371 2ND AVE
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:
10010-6447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-420-7280
Provider Business Mailing Address Fax Number:
212-420-7422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
371 2ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10010-6447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-420-7280
Provider Business Practice Location Address Fax Number:
212-420-7422
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VINLUAN
Authorized Official First Name:
JOANN
Authorized Official Middle Name:
SANTOS
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
212-420-7280

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  021012 , 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: 02204222 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 204250700 . This is a "ACS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2051335 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6603754 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QA7141 . This is a "MEDICARE-INDIVIDUAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QYW191 . This is a "MEDICARE-GROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1461986 . This is a "MAGNACARE PPO MAX" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 04761G . This is a "GHI MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000036361 . This is a "AFFINITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 132123P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2460766 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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