Provider Demographics
NPI:1366642274
Name:HOMEWARD BOUND PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:HOMEWARD BOUND PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSLEY JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-673-6243
Mailing Address - Street 1:520 ADAMS STREET
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1043
Mailing Address - Country:US
Mailing Address - Phone:631-673-6243
Mailing Address - Fax:631-673-6243
Practice Address - Street 1:520 ADAMS STREET
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1043
Practice Address - Country:US
Practice Address - Phone:631-673-6243
Practice Address - Fax:631-673-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0084671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ60801Medicare PIN