Provider Demographics
NPI:1629196514
Name:JAMES FOWLER PT., PC
Entity Type:Organization
Organization Name:JAMES FOWLER PT., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGACHEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-253-9383
Mailing Address - Street 1:873 BROADWAY,
Mailing Address - Street 2:SUITE 510
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1234
Mailing Address - Country:US
Mailing Address - Phone:212-253-9383
Mailing Address - Fax:212-253-5713
Practice Address - Street 1:873 BROADWAY
Practice Address - Street 2:SUITE 510
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1234
Practice Address - Country:US
Practice Address - Phone:212-253-9383
Practice Address - Fax:212-253-5713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014525-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1WFS1Medicare PIN