Provider Demographics
NPI:1497795348
Name:BRONX PHYSICAL THERAPY LLP
Entity Type:Organization
Organization Name:BRONX PHYSICAL THERAPY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-822-2281
Mailing Address - Street 1:3117 BUHRE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4738
Mailing Address - Country:US
Mailing Address - Phone:718-822-2281
Mailing Address - Fax:
Practice Address - Street 1:3117 BUHRE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4738
Practice Address - Country:US
Practice Address - Phone:718-822-2281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006745-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY21701OtherORTHONET FACILITY #
NY0021702OtherAETNA ORTHO FACILITY #
NYCM3831OtherRAILROAD MEDICARE GROUP #
NYANC857OtherOXFORD FACILITY #
NY8450289OtherAETNA PPO GROUP #
NY7870OtherAETNA HMO GROUP #
NY=========OtherTAX ID #
NY8450289OtherAETNA PPO GROUP #