Provider Demographics
NPI:1750862710
Name:ADCA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ADCA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIMILECH
Authorized Official - Middle Name:DELA CRUZ
Authorized Official - Last Name:ANOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-589-2495
Mailing Address - Street 1:4511 40TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3902
Mailing Address - Country:US
Mailing Address - Phone:646-589-2495
Mailing Address - Fax:
Practice Address - Street 1:4511 40TH ST APT 2F
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-3902
Practice Address - Country:US
Practice Address - Phone:646-589-2495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034420-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05754430Medicaid