Provider Demographics
NPI:1184005183
Name:INTEGRATE NYC PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:INTEGRATE NYC PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:O'BANION
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:212-256-0302
Mailing Address - Street 1:240 E 56TH ST
Mailing Address - Street 2:4W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-3755
Mailing Address - Country:US
Mailing Address - Phone:212-256-0302
Mailing Address - Fax:646-304-8434
Practice Address - Street 1:240 E 56TH ST
Practice Address - Street 2:4W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3755
Practice Address - Country:US
Practice Address - Phone:212-256-0302
Practice Address - Fax:646-304-8434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0286921261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000286OtherMEDICARE PTAN