Provider Demographics
NPI:1831382597
Name:OCEAN BAY PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:OCEAN BAY PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:FELICIANO
Authorized Official - Last Name:MAGBAG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-998-7586
Mailing Address - Street 1:2350 OCEAN AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3044
Mailing Address - Country:US
Mailing Address - Phone:718-998-7586
Mailing Address - Fax:718-998-3374
Practice Address - Street 1:2350 OCEAN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3044
Practice Address - Country:US
Practice Address - Phone:718-998-7586
Practice Address - Fax:718-998-3374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY612892600OtherDEPARTMENT OF LABOR
NY0029060OtherORTHONET CIGNA
NY0100202OtherORTHONET HEALTHNET
NY0100202OtherORTHONET HEALTHNET