Provider Demographics
NPI:1922230788
Name:NEW ERA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:NEW ERA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:FORTIN
Authorized Official - Last Name:LOMBOY
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:718-886-0556
Mailing Address - Street 1:13101 39TH AVE
Mailing Address - Street 2:2FL B8
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4420
Mailing Address - Country:US
Mailing Address - Phone:718-886-0556
Mailing Address - Fax:718-886-0522
Practice Address - Street 1:13101 39TH AVE
Practice Address - Street 2:2FL B8
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4420
Practice Address - Country:US
Practice Address - Phone:718-886-0556
Practice Address - Fax:718-886-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300000147Medicare PIN