Provider Demographics
NPI:1558504936
Name:ADVANCED PROCARE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ADVANCED PROCARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:FELICIANO
Authorized Official - Last Name:MAGBAG
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:718-263-2273
Mailing Address - Street 1:9910 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6638
Mailing Address - Country:US
Mailing Address - Phone:718-263-2273
Mailing Address - Fax:
Practice Address - Street 1:9910 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6638
Practice Address - Country:US
Practice Address - Phone:718-263-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022488-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy