1689719072 NPI number — CHRISTINE A ELLIS MS, PT

Table of content: CHRISTINE A ELLIS MS, PT (NPI 1689719072)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689719072 NPI number — CHRISTINE A ELLIS MS, PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIS
Provider First Name:
CHRISTINE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, PT
Provider Gender Code:
F

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:
1689719072
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 MAIN STREER
Provider Second Line Business Mailing Address:
SUITE 202 2ND FLOOR
Provider Business Mailing Address City Name:
TUCKAHOE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10707-2948
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-961-1010
Provider Business Mailing Address Fax Number:
914-961-1011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 202 2ND FLOOR
Provider Business Practice Location Address City Name:
TUCKAHOE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10707-2948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-961-1010
Provider Business Practice Location Address Fax Number:
914-961-1011
Provider Enumeration Date:
02/21/2007

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: 225100000X , with the licence number:  016671 , 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: 0131296 . This is a "AMERIGROUP- HEALTHY1ST MEDICAID, NY MEDICARE BALANCE, NY MEDICARE SPECIALITY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 03282455 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 818164 . This is a "OPTUM PHYSICAL THERAPY OXFORD-CHILD HLTH PLUS,FAMILY HLTH,OXFORD LIBERTY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0401997 . This is a "AETNA ORTHONET MCLEAN AVENUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2689719072-01 . This is a "HHC CHOICES GOLD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: IN NETWORK . This is a "AGEWELL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0401995 . This is a "US FAMILY -ORTHONET TUCKAHOE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 201116700038 . This is a "AFFINITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "VNS-NYS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "AGEWELL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 272438129-001 . This is a "HEALTH 1ST, HEALTH1ST MEDICARE, HEALTH1ST COMPLETECARE, HEALTH1ST COMMERCIAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 703204 . This is a "MPN NY STATE- OPTUM PHYSICAL THERAPY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 786980 . This is a "OPTUM PHYSICAL THERAPY UHC (FACILITY)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: ACS-616130500 . This is a "FECA/OFFICE OF WORKERS COMPENSATION PROGRAMS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: IN NETWORK . This is a "MAGNACARE ADMINISTRSTIVE SERVICES, LLC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QN7941 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0401997 . This is a "CIGNA ORTHONET MCLEAN AVENUE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7964370 . This is a "AETNA LOCAL 1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1251 . This is a "AMIDACARE-GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 272438120 . This is a "FNP MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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