Provider Demographics
NPI:1538129598
Name:RON MEADOR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:RON MEADOR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:MEADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-517-7927
Mailing Address - Street 1:333 E 79TH ST
Mailing Address - Street 2:#1T
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0956
Mailing Address - Country:US
Mailing Address - Phone:212-517-7927
Mailing Address - Fax:212-517-7927
Practice Address - Street 1:333 E 79TH ST
Practice Address - Street 2:#1T
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0956
Practice Address - Country:US
Practice Address - Phone:212-517-7927
Practice Address - Fax:212-517-7927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0085661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL5781Medicare PIN