Basic Information
| Provider Information | |||||||||
| NPI: | 1497205025 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE CENTRAL ORTHOPEDIC GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 651 OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | PLAINVIEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118034938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166818822 | ||||||||
| FaxNumber: | 5166813332 | ||||||||
| Practice Location | |||||||||
| Address1: | 651 OLD COUNTRY RD | ||||||||
| Address2: | |||||||||
| City: | PLAINVIEW | ||||||||
| State: | NY | ||||||||
| PostalCode: | 118034938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5166818822 | ||||||||
| FaxNumber: | 5166813332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2016 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| AuthorizedOfficialLastName: | LETTIERI | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5166818822 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 284591 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 284592 | 01 | NY | LICENSE | OTHER |