Basic Information
| Provider Information | |||||||||
| NPI: | 1346664257 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEUMEISTER | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 489 WILKINSON RD | ||||||||
| Address2: | |||||||||
| City: | MACEDON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 145028809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154304419 | ||||||||
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| Practice Location | |||||||||
| Address1: | 145 HAZARD AVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | ENFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060824521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602652571 | ||||||||
| FaxNumber: | 8602652574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2014 | ||||||||
| LastUpdateDate: | 08/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 038725-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 10045 | 01 | CT | STATE OF CT LICENSE | OTHER |