Provider Demographics
NPI:1982016598
Name:PERSONAL TOUCH MEDICAL OF THROGS NECK REHABILITATION & PHYSICAL MED
Entity Type:Organization
Organization Name:PERSONAL TOUCH MEDICAL OF THROGS NECK REHABILITATION & PHYSICAL MED
Other - Org Name:PERSONAL TOUCH MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:APONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-828-1549
Mailing Address - Street 1:3485 E TREMONT AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2016
Mailing Address - Country:US
Mailing Address - Phone:718-828-1549
Mailing Address - Fax:718-828-5029
Practice Address - Street 1:3485 E TREMONT AVE STE 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2016
Practice Address - Country:US
Practice Address - Phone:718-828-1549
Practice Address - Fax:718-828-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-30
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03242021Medicaid