Basic Information
Provider Information | |||||||||
NPI: | 1265448559 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | NEW YORK PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | COMPLETE CARE PHYSICAL THERAPY @ SPORTSET | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 569 E MAIN STREET | ||||||||
Address2: |   | ||||||||
City: | BAY SHORE | ||||||||
State: | NY | ||||||||
PostalCode: | 117068505 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6316658645 | ||||||||
FaxNumber: | 6316658646 | ||||||||
Practice Location | |||||||||
Address1: | 70 MAPLE AVENUE | ||||||||
Address2: |   | ||||||||
City: | ROCKVILLE CENTRE | ||||||||
State: | NY | ||||||||
PostalCode: | 11570 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5165367388 | ||||||||
FaxNumber: | 8882673128 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2006 | ||||||||
LastUpdateDate: | 07/30/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DEL PERCIO | ||||||||
AuthorizedOfficialFirstName: | IRENE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
AuthorizedOfficialTelephone: | 6316658645 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | NEW YORK PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PLLC | ||||||||
AuthorizedOfficialNamePrefix: | MS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X |   |   | N | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   | 261QP2000X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.