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NPI Code Detail

MEDICARE: HAIDEE GANZ-BONHURST P.T., P.C.

MEDICARE: HAIDEE GANZ-BONHURST P.T., P.C.
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
1261QP2000XPhysical Therapy Clinic/Center010927-1NY

General Provider Information

NPI Number : 1821361478
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAIDEE GANZ-BONHURST P.T., P.C.
Provider Business Mailing Address
First Line : 50 ROUTE 111
Second Line : SUITE 103
City : SMITHTOWN
State : NY
Zip : 11787-3738
Country : US
Telephone Number : 631-360-0723
Fax Number : 631-360-2346
Provider Business Practice Location Address
First Line : 50 ROUTE 111
Second Line : SUITE 103
City : SMITHTOWN
State : NY
Zip : 11787-3738
Country : US
Telephone Number : 631-360-0723
Fax Number : 631-360-2346
Authorized Official
Title or Position : OWNER
Name : MRS. HAIDEE GANZ-BONHURST
Credential : DPT
Telephone Number : 631-360-0723
Provider Enumeration Date : 02/13/2012
Last Update Date : 02/13/2012

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