Provider Demographics
NPI:1518112291
Name:ACTIVE PT,PC
Entity Type:Organization
Organization Name:ACTIVE PT,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINA
Authorized Official - Middle Name:BACARRA
Authorized Official - Last Name:FRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:914-671-8824
Mailing Address - Street 1:8 OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-3116
Mailing Address - Country:US
Mailing Address - Phone:914-671-8824
Mailing Address - Fax:
Practice Address - Street 1:8 OXFORD AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-3116
Practice Address - Country:US
Practice Address - Phone:914-671-8824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-23
Last Update Date:2008-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011817-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency