Healthcare Provider Details
I. General information
NPI: 1306022272
Provider Name (Legal Business Name): MOTION DYNAMICS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 01/10/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
440 WAVERLY AVE STE 5
PATCHOGUE NY
11772-1597
US
IV. Provider business mailing address
440 WAVERLY AVE STE 5
PATCHOGUE NY
11772-1597
US
V. Phone/Fax
- Phone: 631-758-5700
- Fax: 631-758-7005
- Phone: 631-758-5700
- Fax: 631-758-7005
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208100000X |
| Taxonomy | Physical Medicine & Rehabilitation Physician |
| License Number | |
| License Number State | |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 139551P |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | HIP |
| # 2 | |
| Identifier | P1939994 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | OXFORD |
| # 3 | |
| Identifier | P1948798 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | OXFORD |
| # 4 | |
| Identifier | Q86011 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | BLUE CROSS |
| # 5 | |
| Identifier | 2287876 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | AETNA |
| # 6 | |
| Identifier | 4364178 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | AETNA |
| # 7 | |
| Identifier | 20593P |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | HIP |
| # 8 | |
| Identifier | AZ00653 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | MDNY |
| # 9 | |
| Identifier | 0220801 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | AETNA / ORTHO NET |
| # 10 | |
| Identifier | 5442410 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | AETNA |
| # 11 | |
| Identifier | 2284678 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | AETNA |
| # 12 | |
| Identifier | 1259717 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | UNITED HEALTH CARE |
| # 13 | |
| Identifier | 1380287 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | UNITED HEALTH CARE |
| # 14 | |
| Identifier | Q49881 |
| Identifier Type | OTHER |
| Identifier State | NY |
| Identifier Issuer | BLUE CROSS |
VIII. Authorized Official
Name: MR.
STEPHAN
UNGAR
Title or Position: PRESIDENT
Credential: PT
Phone: 631-758-5700
