Basic Information
| Provider Information | |||||||||
| NPI: | 1972744068 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PICKEL | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 WHITE PLAINS RD | ||||||||
| Address2: | |||||||||
| City: | TARRYTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105915837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324933100 | ||||||||
| FaxNumber: | 7324934285 | ||||||||
| Practice Location | |||||||||
| Address1: | 65 N SUSSEX ST | ||||||||
| Address2: | |||||||||
| City: | DOVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 078013949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9733615200 | ||||||||
| FaxNumber: | 9733618312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/19/2009 | ||||||||
| LastUpdateDate: | 03/19/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 40QB00194100 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.