Provider Demographics
NPI:1497063382
Name:HOME PT OF NYC, PLLC
Entity Type:Organization
Organization Name:HOME PT OF NYC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:646-853-5315
Mailing Address - Street 1:1375 BROADWAY
Mailing Address - Street 2:FL 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7001
Mailing Address - Country:US
Mailing Address - Phone:646-853-5315
Mailing Address - Fax:866-863-8148
Practice Address - Street 1:1375 BROADWAY
Practice Address - Street 2:FL 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7001
Practice Address - Country:US
Practice Address - Phone:646-853-5315
Practice Address - Fax:866-863-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012422-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY012422-1OtherNYS LICENSE NUMBER
NYQ38641OtherPTAN