Basic Information
| Provider Information | |||||||||
| NPI: | 1881614295 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PROFORM PHYSICAL THERAPY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 569 E MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BAYSHORE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117068505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6316658645 | ||||||||
| FaxNumber: | 6316658646 | ||||||||
| Practice Location | |||||||||
| Address1: | 317 MIDDLE COUNTRY ROAD | ||||||||
| Address2: | SUITE # 3 | ||||||||
| City: | SMITHTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313619246 | ||||||||
| FaxNumber: | 8882155091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 07/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | DELPERCIO | ||||||||
| AuthorizedOfficialFirstName: | IRENE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6316658645 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY PLLC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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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.