1972166676 NPI number — WIND PHYSICAL THERAPY PC

Table of content: (NPI 1972166676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972166676 NPI number — WIND PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WIND 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:
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:
1972166676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6707 CLOVERDALE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND GARDENS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11364-2742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-567-3870
Provider Business Mailing Address Fax Number:
718-691-4366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24825 NORTHERN BLVD STE 2B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11362-1280
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
190-956-7387
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHOI
Authorized Official First Name:
BONGYONG
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
347-235-4742

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 571812731 . This is a "DRIVER LICENSE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".