Healthcare Provider Details

I. General information

NPI: 1437538915
Provider Name (Legal Business Name): BRONX PHYSICAL THERAPY AND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 MORRIS PARK AVE
BRONX NY
10462-3714
US

IV. Provider business mailing address

1418 ROUTE 300
NEWBURGH NY
12550-2992
US

V. Phone/Fax

Practice location:
  • Phone: 718-823-7676
  • Fax: 718-823-7675
Mailing address:
  • Phone: 845-566-4202
  • Fax: 845-566-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number011191
License Number StateNY

VIII. Authorized Official

Name: MR. SAMUEL IGNACIO
Title or Position: PT
Credential:
Phone: 914-843-8224