1629290796 NPI number — OPTIMUM CARE PHYSICAL THERAPY PC

Table of content: (NPI 1629290796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629290796 NPI number — OPTIMUM CARE PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMUM CARE PHYSICAL THERAPY PC
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:
1629290796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 CANAL STREET
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-625-2818
Provider Business Mailing Address Fax Number:
212-625-2819

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 CANAL STREET
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-625-2818
Provider Business Practice Location Address Fax Number:
212-625-2819
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YIU
Authorized Official First Name:
HO YIN
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
212-625-2818

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  0278331 , 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)

  • Identifier: 02861058 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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