Provider Demographics
NPI:1508800350
Name:BP PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BP PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL OFFICER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADONIS
Authorized Official - Middle Name:ABRIL
Authorized Official - Last Name:QUIAMBAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-936-0565
Mailing Address - Street 1:690 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-3712
Mailing Address - Country:US
Mailing Address - Phone:718-388-8888
Mailing Address - Fax:718-388-3709
Practice Address - Street 1:690 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-3712
Practice Address - Country:US
Practice Address - Phone:718-388-8888
Practice Address - Fax:718-388-3709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11514299OtherCAQH
NY7795346OtherAETNA PPO
NY8863880OtherCIGNA
NY0021901OtherORTHONET
NY841850OtherMPN
NY2822127OtherAETNA HMO
NY841850OtherMPN
NY8863880OtherCIGNA