Healthcare Provider Details

I. General information

NPI: 1437303518
Provider Name (Legal Business Name): VERNON REHAB & PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2008
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 STRAWTOWN RD SUITE 4,5
WEST NYACK NY
10994-3514
US

IV. Provider business mailing address

2 STRAWTOWN RD SUITE 4, 5
WEST NYACK NY
10994-3514
US

V. Phone/Fax

Practice location:
  • Phone: 845-358-0019
  • Fax: 845-358-3921
Mailing address:
  • Phone: 845-358-0019
  • Fax: 845-358-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number021666-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number021666-1
License Number StateNY

VIII. Authorized Official

Name: SAJAN AUGUSTINE
Title or Position: PRESIDENT
Credential: PHYSICAL THERAPIST
Phone: 914-843-4155