Basic Information
| Provider Information | |||||||||
| NPI: | 1679593081 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 569 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BAY SHORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117068505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316658645 | ||||||||
| FaxNumber: | 6316658646 | ||||||||
| Practice Location | |||||||||
| Address1: | 5499 ROUTE 347 | ||||||||
| Address2: | |||||||||
| City: | MOUNT SINAI | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313313910 | ||||||||
| FaxNumber: | 6313313986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 11/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | BOWIE | ||||||||
| AuthorizedOfficialFirstName: | DOUG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6316658645 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY PLLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.