MEDICARE: RIVERDALE PHYSICAL THERAPY PC

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
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0025501	OTHER	NY	ORTHONET HEALTHNET
2	M4252P	OTHER	NY	HIP
3	0030977	OTHER	NY	GHI
4	90478	OTHER	NY	AETNA
5	25501	OTHER	NY	ORTHONET CIGNA
6	4C8041	OTHER	NY	HEALTHNET
7	Q10492	OTHER	NY	BLUE CROSS
8	0025501	OTHER	NY	ORTHONET AETNA
9	000305900101	OTHER	NY	HEALTHPLUS
10	001395A81	OTHER	NY	HEALTHFIRST
11	GS016	OTHER	NY	OXFORD
12	000000058810	OTHER	NY	GHI HMO

General Provider Information

NPI Number	:	1538192067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERDALE PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	2735 HENRY HUDSON PKWY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4701
Country	:	US
Telephone Number	:	718-884-0444
Fax Number	:	718-549-0145

Provider Business Practice Location Address
First Line	:	2735 HENRY HUDSON PKWY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4701
Country	:	US
Telephone Number	:	718-884-0444
Fax Number	:	718-549-0145

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JERROLD MANN
Credential	:	PT
Telephone Number	:	718-884-0444

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	04/14/2008

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