Provider Demographics
NPI:1952392680
Name:NY PHYSICAL THERAPY & WELLNESS, LEVITTOWN, PLLC
Entity type:Organization
Organization Name:NY PHYSICAL THERAPY & WELLNESS, LEVITTOWN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:BREDOW
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-520-7200
Mailing Address - Street 1:150 GARDINERS AVE
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3707
Mailing Address - Country:US
Mailing Address - Phone:516-520-7200
Mailing Address - Fax:516-520-7625
Practice Address - Street 1:150 GARDINERS AVE
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3707
Practice Address - Country:US
Practice Address - Phone:516-520-7200
Practice Address - Fax:516-520-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021022-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY162552POtherHIP
NYQ13C11OtherEMPIRE BC/BS
NYQ13C11OtherEMPIRE BC/BS