Basic Information
Provider Information
NPI: 1104292531
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DEHEY
FirstName: MEGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2142 UTOPIA PKWY
Address2:  
City: WHITESTONE
State: NY
PostalCode: 113574142
CountryCode: US
TelephoneNumber: 7188196800
FaxNumber: 3478419109
Practice Location
Address1: 420 LEXINGTON AVE
Address2: C/O EQUINOX
City: NEW YORK
State: NY
PostalCode: 101700002
CountryCode: US
TelephoneNumber: 2129730655
FaxNumber: 2129730656
Other Information
ProviderEnumerationDate: 08/20/2015
LastUpdateDate: 08/20/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X039284NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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