Provider Demographics
NPI:1437303518
Name:VERNON REHAB & PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:VERNON REHAB & PHYSICAL THERAPY PC
Other - Org Name:WEST NYACK SPORTS MEDICINE &PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUGUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:914-843-4155
Mailing Address - Street 1:2 STRAWTOWN RD
Mailing Address - Street 2:SUITE 4, 5
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-3514
Mailing Address - Country:US
Mailing Address - Phone:845-358-0019
Mailing Address - Fax:845-358-3921
Practice Address - Street 1:2 STRAWTOWN RD
Practice Address - Street 2:SUITE 4,5
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-3514
Practice Address - Country:US
Practice Address - Phone:845-358-0019
Practice Address - Fax:845-358-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-16
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021666-1261QP2000X, 320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100044529Medicare PIN