Provider Demographics
NPI:1649636978
Name:PROCORE PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:PROCORE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:845-680-2673
Mailing Address - Street 1:135 E ERIE ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:BLAUVELT
Mailing Address - State:NY
Mailing Address - Zip Code:10913-1823
Mailing Address - Country:US
Mailing Address - Phone:845-680-2673
Mailing Address - Fax:845-680-2675
Practice Address - Street 1:135 E ERIE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1823
Practice Address - Country:US
Practice Address - Phone:845-680-2673
Practice Address - Fax:845-680-2675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018483-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ2W2C1OtherMEDICARE NUMBER