Provider Demographics
NPI:1821361478
Name:HAIDEE GANZ-BONHURST P.T., P.C.
Entity Type:Organization
Organization Name:HAIDEE GANZ-BONHURST P.T., P.C.
Other - Org Name:METROPOLITAN PHYSICAL THERAPY EAST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HAIDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANZ-BONHURST
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-360-0723
Mailing Address - Street 1:50 ROUTE 111
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3738
Mailing Address - Country:US
Mailing Address - Phone:631-360-0723
Mailing Address - Fax:631-360-2346
Practice Address - Street 1:50 ROUTE 111
Practice Address - Street 2:SUITE 103
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3738
Practice Address - Country:US
Practice Address - Phone:631-360-0723
Practice Address - Fax:631-360-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010927-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy