Provider Demographics
NPI:1922058981
Name:GANZ-BONHURST, HAIDEE RAE (DPT, MS,AT,C)
Entity Type:Individual
Prefix:DR
First Name:HAIDEE
Middle Name:RAE
Last Name:GANZ-BONHURST
Suffix:
Gender:F
Credentials:DPT, MS,AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:11787-3700
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:11787-3700
Practice Address - Country:US
Practice Address - Phone:631-360-0723
Practice Address - Fax:631-360-2346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010927-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0003850OtherINDEPENDENT HEALTH
NY0510681OtherU.S. HEALTHCARE
NY77273OtherVYTRA
NY34501OtherCIGNA-ORTHONET
NY6601841OtherGHI
NYANC1171OtherOXFORD
NY129689POtherHIP
NY970302OtherCIGNA
NYAZ00431AOtherMDNY
NYAZ00431AOtherMDNY