Provider Demographics
NPI:1093860595
Name:HECTORPT SENIOR REHABILITATION SERVICES, PT, OT, SLP, PLLC
Entity Type:Organization
Organization Name:HECTORPT SENIOR REHABILITATION SERVICES, PT, OT, SLP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:JASEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-371-5554
Mailing Address - Street 1:PO BOX 11471
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-0471
Mailing Address - Country:US
Mailing Address - Phone:518-389-1802
Mailing Address - Fax:
Practice Address - Street 1:1 WALL ST
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3851
Practice Address - Country:US
Practice Address - Phone:518-371-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0222352251G0304X
225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02872104Medicaid
NY=========OtherTIN