Provider Demographics
NPI:1417061896
Name:RIVERDALE SPORTS PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:RIVERDALE SPORTS PHYSICAL THERAPY PC
Other - Org Name:METRO SPORTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-432-1323
Mailing Address - Street 1:32-65 JOHNSON AVE
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-432-1323
Mailing Address - Fax:718-432-1326
Practice Address - Street 1:32-65 JOHNSON AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-432-1323
Practice Address - Fax:718-432-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022885-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6401310OtherUNITED HEALTHCARE
209968POtherHIP PRIS#
6698279OtherGHI
839609OtherMPN
180057OtherELDERPLAN
2581814OtherCIGNA
100040667OtherAFFINITY
022885 SOtherHORIZON
2068OtherMAGNACARE
7068699OtherAETNA
QP7403OtherEMPIRE BCBS
P3600980OtherOXFORD
2068OtherMAGNACARE