1841406980 NPI number — BROOKHAVEN PHYSICAL THERAPY

Table of content: (NPI 1841406980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841406980 NPI number — BROOKHAVEN PHYSICAL THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOKHAVEN PHYSICAL THERAPY
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:
1841406980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 ECHO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLER PLACE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11764-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-331-2348
Provider Business Mailing Address Fax Number:
631-928-7068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MIDDLE COUNTRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLE ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11953-2520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-345-2005
Provider Business Practice Location Address Fax Number:
631-345-5007
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCCREA
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-345-2005

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  011801-1 , 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: 0210001 . This is a "HEALTHNET ORTHONET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12067099 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DM0Q03821 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6602110 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 813476 . This is a "MPN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A493957 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 20473P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: AZ00671 . This is a "MDNY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 107487200 . This is a "ACS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2176073 . This is a "FIRST HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 124896 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1295268 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1C0216 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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