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NPI Code Detail

MEDICARE: DEER PARK PHYSICAL THERAPY AND CHIROPRACTIC PLLC

MEDICARE: DEER PARK PHYSICAL THERAPY AND CHIROPRACTIC PLLC
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
1225100000XPhysical Therapist021022-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10401575OTHERCIGNA
26697450OTHERGHI
3771360POTHERHIP
4Q13V53OTHERNYBCBS
5P3369855OTHERNYOXFORD

General Provider Information

NPI Number : 1841608841
Entity Type Code : Organization
Provider Name (Legal Business Name) : DEER PARK PHYSICAL THERAPY AND CHIROPRACTIC PLLC
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 : OWNER, PHYSICAL THERAPIST
Name : RONALD JOSEPH BREDOW
Credential : MS, PT
Telephone Number : 631-242-4500
Provider Enumeration Date : 07/23/2014
Last Update Date : 05/13/2015

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