Provider Demographics
NPI:1346323813
Name:SOUTHAMPTON HOSPITAL/SPORTS REHAB WH
Entity Type:Organization
Organization Name:SOUTHAMPTON HOSPITAL/SPORTS REHAB WH
Other - Org Name:SPORTS REHAB WH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/SITE LEADER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-288-7767
Mailing Address - Street 1:74 OLD RIVERHEAD RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11978-1401
Mailing Address - Country:US
Mailing Address - Phone:631-288-7767
Mailing Address - Fax:631-288-7100
Practice Address - Street 1:74 OLD RIVERHEAD RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON BEACH
Practice Address - State:NY
Practice Address - Zip Code:11978
Practice Address - Country:US
Practice Address - Phone:631-288-7767
Practice Address - Fax:631-288-7100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004540-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY022570OtherHIP-PETER FISCINA, P.T.
NYQH5051OtherBC-BS-EILEEN SOLJANICH,PT
NYQH5392OtherBCBS-TONI WORMOLD,P.T.
NY2365871OtherAETNA
NY6698019OtherGHI-EILEEN SOLJANICH,P.T.
NY018611OtherHIP-TONI WORMOLD, P.T.
NY32803OtherUS FAMILY HEALTH-SPORTS
NY6698017OtherGHI-CHRISTINE SMITHBARTON
NYAZ00175OtherMDNY-
NY015752-A64OtherHEALTHFIRST-E.S.,P.T.
NY32803OtherCIGNA-SPORTS REHAB WH
NY6698021OtherGHI-PETER M. FISCINA, P.T
NY00274406Medicaid
NYQN0681OtherBCBS-PETER FISCINA,P.T.
NY58418OtherVYTRA
NY6698016OtherGHI-TONI L. WORMOLD,P.T.
NYQH5061OtherBCBS CHRISTINESMITHBARTON
NY6698018OtherGHI-STEVE ZACHARSKI
NY00274406Medicaid
NY6698018OtherGHI-STEVE ZACHARSKI