Provider Demographics
NPI:1073625901
Name:JEFFREY J SANOIAN PT PC
Entity Type:Organization
Organization Name:JEFFREY J SANOIAN PT PC
Other - Org Name:ALL SPORT & SPINE PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT DIRECTOR OF PHYSICAL THER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SANOIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:845-639-1181
Mailing Address - Street 1:20 SQUADRON BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-639-1181
Mailing Address - Fax:845-639-4685
Practice Address - Street 1:20 SQUADRON BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-639-1181
Practice Address - Fax:845-639-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0145241225100000X
CT004481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q20631Medicare ID - Type Unspecified
NYQ20631Medicare PIN