Provider Demographics
NPI:1912237264
Name:I-OM PHYSICAL THERAPY P.C
Entity Type:Organization
Organization Name:I-OM PHYSICAL THERAPY P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENCONSEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-571-4800
Mailing Address - Street 1:15 PARK ROW
Mailing Address - Street 2:15J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2301
Mailing Address - Country:US
Mailing Address - Phone:917-658-0955
Mailing Address - Fax:
Practice Address - Street 1:111 JOHN ST
Practice Address - Street 2:SUITE 1445
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3101
Practice Address - Country:US
Practice Address - Phone:917-715-1540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-09
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023922-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ12X23OtherMEDICARE ID