Provider Demographics
NPI:1184840670
Name:ORANGE LAKE PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:ORANGE LAKE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:CATALUSCI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-566-4303
Mailing Address - Street 1:211 S PLANK RD STE 3
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-7050
Mailing Address - Country:US
Mailing Address - Phone:845-566-4303
Mailing Address - Fax:845-566-4255
Practice Address - Street 1:211 S PLANK RD STE 3
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-7050
Practice Address - Country:US
Practice Address - Phone:845-566-4303
Practice Address - Fax:845-566-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1W2C1Medicare PIN