1841522190 NPI number — SUPREME CARE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY, PLLC

Table of content: MR. RAMON VICENTE MARTINEZ RPH (NPI 1851473797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841522190 NPI number — SUPREME CARE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPREME CARE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY, PLLC
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:
6
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:
1841522190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3319 AVENUE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11234-2605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-258-3300
Provider Business Mailing Address Fax Number:
718-258-3301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3319 AVENUE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-258-3300
Provider Business Practice Location Address Fax Number:
718-258-3301
Provider Enumeration Date:
02/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
EZRICK
Authorized Official First Name:
LOUIS
Authorized Official Middle Name:
WINSTON
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-258-3300

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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