Provider Demographics
NPI:1649324450
Name:OPTIMA PHYSICAL THERAPY REHABILITATION PC
Entity type:Organization
Organization Name:OPTIMA PHYSICAL THERAPY REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:AKINLOYE
Authorized Official - Last Name:OLOKUNGBEMI
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:718-324-8166
Mailing Address - Street 1:PO BOX 1031
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-7031
Mailing Address - Country:US
Mailing Address - Phone:718-324-8166
Mailing Address - Fax:718-324-7539
Practice Address - Street 1:4626 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1610
Practice Address - Country:US
Practice Address - Phone:718-324-8166
Practice Address - Fax:718-324-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015375261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY660533OtherGHI PPO
NYQP768OtherBLUE CROSS BLUE SHIELD
NY000000073981-BOtherGHI HMO
NY105663900OtherDEPT. OF LABOR
NYDE3680OtherRAILROAD MEDICARE
NY05714GOtherGHI MEDICARE
NY121300POtherHIP
NYP-11231046OtherMULTIPLAN
NY228870OtherWELLCARE
NY0P015375OtherMETROPLUS
NY2292361OtherUNITED HEALTH CARE
NY01701817Medicaid
NY201130400016OtherAFFINITY
NY6202200OtherCIGNA
NY660533OtherGHI PPO
NY=========OtherHORIZON
NY=========OtherFIRST HEALTH
NY=========OtherFIDELIS
NYQP768OtherBLUE CROSS BLUE SHIELD
NY0P015375OtherMETROPLUS