Provider Demographics
NPI:1700327087
Name:SUMMIT PHYSICAL THERAPY AND REHABILITATION, PLLC
Entity Type:Organization
Organization Name:SUMMIT PHYSICAL THERAPY AND REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-656-4109
Mailing Address - Street 1:1760 DUTCH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-5006
Mailing Address - Country:US
Mailing Address - Phone:347-656-4109
Mailing Address - Fax:
Practice Address - Street 1:1763 DUTCH BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-5044
Practice Address - Country:US
Practice Address - Phone:347-656-4109
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY032724Medicare UPIN