Basic Information
| Provider Information | |||||||||
| NPI: | 1811967680 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NANI | ||||||||
| FirstName: | FRANK | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHYSICAL THERIPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 PARKER RD | ||||||||
| Address2: | |||||||||
| City: | GARNERVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109231909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456384040 | ||||||||
| FaxNumber: | 8456384184 | ||||||||
| Practice Location | |||||||||
| Address1: | 345 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109564305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456384040 | ||||||||
| FaxNumber: | 8456384184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0112251 | NY | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 42082P | 01 | NY | HIP | OTHER | 6601305 | 01 | NY | GHI | OTHER | RS304 | 01 | NM | OXFORD | OTHER |