Provider Demographics
NPI:1821194200
Name:BLAUVELT QUALITY CARE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BLAUVELT QUALITY CARE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:212-369-2040
Mailing Address - Street 1:158 E 100TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6274
Mailing Address - Country:US
Mailing Address - Phone:212-369-2040
Mailing Address - Fax:212-369-2949
Practice Address - Street 1:158 E 100TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6274
Practice Address - Country:US
Practice Address - Phone:212-369-2040
Practice Address - Fax:212-369-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024223-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty