1477160745 NPI number — DR. DANIEL TIMON SCORTEA PT, DPT

Table of content: DR. DANIEL TIMON SCORTEA PT, DPT (NPI 1477160745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477160745 NPI number — DR. DANIEL TIMON SCORTEA PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCORTEA
Provider First Name:
DANIEL
Provider Middle Name:
TIMON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
M

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:
1477160745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 MAYBROOK RD STE L
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMPBELL HALL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10916-2741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-636-4344
Provider Business Mailing Address Fax Number:
845-636-4355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 THIELLS MOUNT IVY RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10970-3038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-694-8808
Provider Business Practice Location Address Fax Number:
845-694-8809
Provider Enumeration Date:
09/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  046223 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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