Provider Demographics
NPI:1306022272
Name:MOTION DYNAMICS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:MOTION DYNAMICS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UNGAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-758-5700
Mailing Address - Street 1:440 WAVERLY AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1597
Mailing Address - Country:US
Mailing Address - Phone:631-758-5700
Mailing Address - Fax:631-758-7005
Practice Address - Street 1:440 WAVERLY AVE STE 5
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1597
Practice Address - Country:US
Practice Address - Phone:631-758-5700
Practice Address - Fax:631-758-7005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY139551POtherHIP
NYP1939994OtherOXFORD
NYP1948798OtherOXFORD
NYQ86011OtherBLUE CROSS
NY2287876OtherAETNA
NY4364178OtherAETNA
NY20593POtherHIP
NYAZ00653OtherMDNY
NY0220801OtherAETNA / ORTHO NET
NY5442410OtherAETNA
NY2284678OtherAETNA
NY1259717OtherUNITED HEALTH CARE
NY1380287OtherUNITED HEALTH CARE
NYQ49881OtherBLUE CROSS
NY2284678OtherAETNA
NY=========OtherISLAND GROUP
NYQ86011OtherBLUE CROSS
NYP1939994OtherOXFORD