Provider Demographics
NPI:1124344296
Name:OMNICARE THERAPY SERVICES, PT, PLLC
Entity type:Organization
Organization Name:OMNICARE THERAPY SERVICES, PT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ACE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMAGAYSAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:718-564-3687
Mailing Address - Street 1:1964 LURTING AVE
Mailing Address - Street 2:APT. 2B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1333
Mailing Address - Country:US
Mailing Address - Phone:347-621-4524
Mailing Address - Fax:347-621-4524
Practice Address - Street 1:1964 LURTING AVE
Practice Address - Street 2:APT. 2B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1333
Practice Address - Country:US
Practice Address - Phone:347-621-4524
Practice Address - Fax:347-621-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty