Provider Demographics
NPI:1578703013
Name:A.R.C. PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:A.R.C. PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMADO
Authorized Official - Middle Name:EDGARDO
Authorized Official - Last Name:CONANAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:917-660-6095
Mailing Address - Street 1:5718 WOODSIDE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3444
Mailing Address - Country:US
Mailing Address - Phone:718-205-0030
Mailing Address - Fax:
Practice Address - Street 1:5718 WOODSIDE AVE FL 2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-3444
Practice Address - Country:US
Practice Address - Phone:718-205-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02527282Medicaid
NY07507Medicare PIN