Provider Demographics
NPI:1437538915
Name:BRONX PHYSICAL THERAPY AND REHABILITATION
Entity Type:Organization
Organization Name:BRONX PHYSICAL THERAPY AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-843-8224
Mailing Address - Street 1:1418 ROUTE 300
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2992
Mailing Address - Country:US
Mailing Address - Phone:845-566-4202
Mailing Address - Fax:845-566-4238
Practice Address - Street 1:984 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3714
Practice Address - Country:US
Practice Address - Phone:718-823-7676
Practice Address - Fax:718-823-7675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011191261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy