Provider Demographics
NPI:1881867414
Name:HEALTH BRIDGE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:HEALTH BRIDGE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOMTOBIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-627-0303
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-627-0303
Mailing Address - Fax:516-627-1399
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-627-0303
Practice Address - Fax:516-627-1399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0259021225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWQ8481Medicare PIN