Provider Demographics
NPI:1386677920
Name:PERFORMING ARTS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:PERFORMING ARTS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PADRIC
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-245-7178
Mailing Address - Street 1:13 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-3905
Mailing Address - Country:US
Mailing Address - Phone:212-245-7278
Mailing Address - Fax:212-245-7461
Practice Address - Street 1:13 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-3905
Practice Address - Country:US
Practice Address - Phone:212-245-7278
Practice Address - Fax:212-245-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009366-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12067507OtherMULTIPLAN
NY4261314OtherCIGNA PPO PAR
NY77A0121OtherABC HEALTHPLAN
NYQ63523OtherEBCBS HMO
NY4417349OtherAETNA NON-PAR
NY0107301OtherHEALTHNET ORTHONET
NY08009814NY01OtherANTHEM HEALTHPLAN
NY2C0813OtherHEALTHNET
NYP2166797OtherOXFORD
NYP2166797OtherOXFORD