Provider Demographics
NPI:1689900037
Name:MONROE PHYSICAL THERAPY091
Entity Type:Organization
Organization Name:MONROE PHYSICAL THERAPY091
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-782-7780
Mailing Address - Street 1:845 STATE ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1606
Mailing Address - Country:US
Mailing Address - Phone:845-782-7780
Mailing Address - Fax:845-782-9270
Practice Address - Street 1:845 STATE ROUTE 17M
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1606
Practice Address - Country:US
Practice Address - Phone:845-782-7780
Practice Address - Fax:845-782-9270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6498261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center