1831382597 NPI number — OCEAN BAY PHYSICAL THERAPY PLLC

Table of content: (NPI 1831382597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831382597 NPI number — OCEAN BAY PHYSICAL THERAPY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OCEAN BAY PHYSICAL THERAPY 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:
1831382597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2350 OCEAN AVE
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11229-3044
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-998-7586
Provider Business Mailing Address Fax Number:
718-998-3374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2350 OCEAN AVE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-3044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-998-7586
Provider Business Practice Location Address Fax Number:
718-998-3374
Provider Enumeration Date:
08/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MAGBAG
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
FELICIANO
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
718-998-7586

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 612892600 . This is a "DEPARTMENT OF LABOR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0029060 . This is a "ORTHONET CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0100202 . This is a "ORTHONET HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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