Provider Demographics
NPI:1265448559
Name:NEW YORK PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PLLC
Entity Type:Organization
Organization Name:NEW YORK PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PLLC
Other - Org Name:COMPLETE CARE PHYSICAL THERAPY @ SPORTSET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL PERCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-665-8645
Mailing Address - Street 1:569 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8505
Mailing Address - Country:US
Mailing Address - Phone:631-665-8645
Mailing Address - Fax:631-665-8646
Practice Address - Street 1:70 MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-536-7388
Practice Address - Fax:888-267-3128
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q5W211Medicare ID - Type Unspecified
Q5W211Medicare UPIN