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NPI Code Detail

MEDICARE: DEER PARK PHYSICAL THERAPY & CHIROPRACTIC

MEDICARE: DEER PARK PHYSICAL THERAPY & CHIROPRACTIC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist021022-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10401575OTHERNYCIGNA
2825077OTHERNYACN
30401575OTHERNYORTHONET
4P3369855OTHEROXFORD
5825077OTHERNYMPN
62166308OTHERNYUHC
7Q13V53OTHERBCBS

General Provider Information

NPI Number : 1750782256
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEER PARK PHYSICAL THERAPY & CHIROPRACTIC
Provider Business Mailing Address
First Line : 2103 DEER PARK AVE
Second Line :
City : DEER PARK
State : NY
Zip : 11729-1319
Country : US
Telephone Number : 631-242-4500
Fax Number : 631-242-0885
Provider Business Practice Location Address
First Line : 2103 DEER PARK AVE
Second Line :
City : DEER PARK
State : NY
Zip : 11729-1319
Country : US
Telephone Number : 631-242-4500
Fax Number : 631-242-0885
Authorized Official
Title or Position : PHYSICAL THERAPY, OWNER
Name : RONALD BREDOW
Credential : MS, PT
Telephone Number : 516-315-2010
Provider Enumeration Date : 09/16/2014
Last Update Date : 09/16/2014

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Directions to “DEER PARK PHYSICAL THERAPY & CHIROPRACTIC ” Practice Location

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