1871783779 NPI number — JWG PHYSICAL THERAPY PC

Table of content: (NPI 1871783779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871783779 NPI number — JWG PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JWG 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:
1871783779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SCHOOL ST
Provider Second Line Business Mailing Address:
SUITE 105A
Provider Business Mailing Address City Name:
GLEN COVE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11542-2545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-656-4824
Provider Business Mailing Address Fax Number:
516-656-4833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SCHOOL ST
Provider Second Line Business Practice Location Address:
SUITE 105A
Provider Business Practice Location Address City Name:
GLEN COVE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11542-2545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-656-4824
Provider Business Practice Location Address Fax Number:
516-656-4833
Provider Enumeration Date:
07/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARDINER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
516-656-4824

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  5249 , 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: 136840 . This is a "VYTRA PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 2904019 . This is a "AETNA PPO PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 58958P . This is a "HIP PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2720801 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 100206834602 . This is a "UNITED HEALTHCARE-MEDICAI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0026201 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 600934000 . This is a "DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 273729 . This is a "1199 PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5C7048 . This is a "HEALTHNET PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 6605247 . This is a "GHI PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7004397 . This is a "AETNA HMO PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: QN6301 . This is a "EMPIRE PROVIDER NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com