Provider Demographics
NPI:1003144106
Name:CHENANGO THERAPEUTICS
Entity Type:Organization
Organization Name:CHENANGO THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GARZIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:607-334-6273
Mailing Address - Street 1:280 COUNTY ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-2209
Mailing Address - Country:US
Mailing Address - Phone:607-334-6273
Mailing Address - Fax:607-334-8770
Practice Address - Street 1:280 COUNTY ROAD 44
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-2209
Practice Address - Country:US
Practice Address - Phone:607-334-6273
Practice Address - Fax:607-334-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003887-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00570645Medicaid
NYR54958Medicare UPIN