Basic Information
| Provider Information | |||||||||
| NPI: | 1063454577 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPEAR PHYSICAL AND OCCUPATIONAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 5TH AVENUE | ||||||||
| Address2: | 6TH FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127592282 | ||||||||
| FaxNumber: | 2123792123 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 E 56TH ST | ||||||||
| Address2: | SUITE 1010 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100223607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127592211 | ||||||||
| FaxNumber: | 2128291189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 09/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | ROOTENBERG | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2127592211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT, DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 017761-1 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
ID Information
| ID | Type | State | Issuer | Description | P1540441 | 01 | NY | OXFORD | OTHER | 32101 | 01 | NY | CIGNA | OTHER | BCBS - Q5W3A1 | 01 | NY | BCBS | OTHER |