Provider Demographics
NPI:1689754129
Name:IRM,PT,P.C.
Entity Type:Organization
Organization Name:IRM,PT,P.C.
Other - Org Name:PTPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-368-2180
Mailing Address - Street 1:28B INDIAN ROCK PL
Mailing Address - Street 2:ROUTE 59
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4907
Mailing Address - Country:US
Mailing Address - Phone:845-368-2180
Mailing Address - Fax:845-368-2187
Practice Address - Street 1:28B INDIAN ROCK PL
Practice Address - Street 2:ROUTE 59
Practice Address - City:MONTEBELLO
Practice Address - State:NY
Practice Address - Zip Code:10901-4907
Practice Address - Country:US
Practice Address - Phone:845-368-2180
Practice Address - Fax:845-368-2187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4001261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0226401OtherAETNA ORTHONET
NY1942234471OtherNPI NUMBER
NY1053311324OtherNPI NUMBER
NY1104819812OtherNPI NUMBER
NYQM7401Medicare ID - Type UnspecifiedPHYSICAL THERAPIST
NY1053311324OtherNPI NUMBER
NY1689754129Medicare PIN
NY1104819812OtherNPI NUMBER