1376630905 NPI number — FIRST CLASS PHYSICAL THERAPY, P.C.

Table of content: (NPI 1376630905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376630905 NPI number — FIRST CLASS PHYSICAL THERAPY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CLASS PHYSICAL THERAPY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376630905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 HEDGEROW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANALAPAN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07726-7905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-996-1100
Provider Business Mailing Address Fax Number:
718-676-9511

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3514 MERMAID AVE
Provider Second Line Business Practice Location Address:
SUITE 003
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11224-1508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-996-1100
Provider Business Practice Location Address Fax Number:
718-676-9511
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHROMCHENKO
Authorized Official First Name:
PAVEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-996-1100

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  019225 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: 028641 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 018570 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 032358 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 032340 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 031898 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 032531 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 033556 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 030156 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 035869 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 036226 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 005486 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 005573 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 005550 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225200000X , with the licence number: 008315 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02186065 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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