Provider Demographics
NPI:1386628683
Name:NY PHYSICAL THERAPY & WELLNESS
Entity Type:Organization
Organization Name:NY PHYSICAL THERAPY & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREDOW
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:631-694-0005
Mailing Address - Street 1:535 BROADHOLLOW RD
Mailing Address - Street 2:SUITE A10
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3713
Mailing Address - Country:US
Mailing Address - Phone:631-694-0005
Mailing Address - Fax:631-694-0007
Practice Address - Street 1:535 BROADHOLLOW RD
Practice Address - Street 2:SUITE A10
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3713
Practice Address - Country:US
Practice Address - Phone:631-694-0005
Practice Address - Fax:631-694-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherHORIZON
NY=========OtherLOCAL 1199
NY=========OtherMULTIPLAN
NY=========OtherCIGNA
NY=========OtherGHI
NY=========OtherMAGNACARE
NY=========OtherMPN
NY=========OtherBEECH STREET
NY=========OtherAETNA
NY=========OtherHUMANA