Provider Demographics
NPI:1598964934
Name:ROBERT BERKLEY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ROBERT BERKLEY PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-343-5095
Mailing Address - Street 1:9 BRIDIE SQUARE
Mailing Address - Street 2:PO BOX 3052
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-0752
Mailing Address - Country:US
Mailing Address - Phone:315-343-5095
Mailing Address - Fax:315-326-0100
Practice Address - Street 1:9 BRIDIE SQUARE
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-0752
Practice Address - Country:US
Practice Address - Phone:315-343-5095
Practice Address - Fax:315-326-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016530305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000166151OtherBLUE CROSS BLUE SHEILD
NY02449076Medicaid
NYY37973Medicare UPIN
NYBA0601Medicare PIN