Provider Demographics
NPI:1396029807
Name:HADER PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:HADER PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WINHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-680-6800
Mailing Address - Street 1:18 E 116TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-1041
Mailing Address - Country:US
Mailing Address - Phone:212-828-8844
Mailing Address - Fax:718-524-6228
Practice Address - Street 1:18 E 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1041
Practice Address - Country:US
Practice Address - Phone:212-828-8844
Practice Address - Fax:718-524-6228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03224531Medicaid