Provider Demographics
NPI:1407976350
Name:LOWER HUDSON VALLEY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:LOWER HUDSON VALLEY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FORREST
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-354-1944
Mailing Address - Street 1:PO BOX 115
Mailing Address - Street 2:11 MEDICAL PARK DR.
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-0115
Mailing Address - Country:US
Mailing Address - Phone:845-354-1944
Mailing Address - Fax:845-354-0189
Practice Address - Street 1:11 MEDICAL PARK DR
Practice Address - Street 2:SUITE 204
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3559
Practice Address - Country:US
Practice Address - Phone:845-354-1944
Practice Address - Fax:845-354-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6023 AND 5474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRS082OtherOXFORD HEALTH INS ID
NM26601OtherORTHONET ID
NY1578695003OtherNPI
NMRS084OtherOXFORD HEALTH INS. ID
NY1457311706OtherNPI
NYQ54801Medicare ID - Type UnspecifiedPROVIDER ID
NMRS084OtherOXFORD HEALTH INS. ID