Provider Demographics
NPI: | 1265488910 |
---|---|
Name: | DEMAY, DONALD C JR (PT) |
Entity Type: | Individual |
Prefix: | |
First Name: | DONALD |
Middle Name: | C |
Last Name: | DEMAY |
Suffix: | JR |
Gender: | M |
Credentials: | PT |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 10 COLUMBUS CIR |
Mailing Address - Street 2: | C/O EQUINOX @ 60TH ST |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10019-1158 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 212-823-9730 |
Mailing Address - Fax: | 212-823-9731 |
Practice Address - Street 1: | 10 COLUMBUS CIR |
Practice Address - Street 2: | C/O EQUINOX @ 60TH ST |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10019-1158 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-823-9730 |
Practice Address - Fax: | 212-823-9731 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-25 |
Last Update Date: | 2012-10-29 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 12086 | 225100000X |
NJ | 40QA01453700 | 225100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NY | QB4261 | Medicare ID - Type Unspecified | EMPIRE MEDICARE |
NJ | 255040YJ3M | Medicare PIN |