Provider Demographics
NPI:1598029522
Name:NORTHERN, RAY ANTHONY (DPT)
Entity Type:Individual
Prefix:
First Name:RAY
Middle Name:ANTHONY
Last Name:NORTHERN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 AVENUE OF THE AMERICAS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10020-1001
Mailing Address - Country:US
Mailing Address - Phone:646-562-0617
Mailing Address - Fax:212-302-1106
Practice Address - Street 1:1221 AVENUE OF THE AMERICAS
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10020-1001
Practice Address - Country:US
Practice Address - Phone:646-562-0617
Practice Address - Fax:212-302-1106
Is Sole Proprietor?:No
Enumeration Date:2012-06-25
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist