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General NPI Number Information
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NPI Number | 1487639993
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Entity Type | Organization
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Legal Business Name | NYCONN ORTHOPAEDIC & REHABILITATION SPECIALISTS, PLLC
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Dates
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Enumeration Date | 12/08/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 667 STONELEIGH AVE SUITE 302
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City | CARMEL
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State | NY
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Zip | 10512-2454
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Country | US
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Telephone | 914-279-5550
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Fax | 914-279-3490
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Provider Business Mailing Address
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Address Line | 8 LONG POND RD
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City | WACCABUC
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State | NY
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Zip | 10597-1013
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Country | US
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Telephone | 914-763-0068
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MRS. JOHANNA ELIZABETH LUBBE
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Credential | BSC.PHYS.HONS.
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Telephone | 845-279-5550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 009815-1
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License Number State | NY
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