Provider Demographics
NPI:1447336193
Name:BRONX PHYSICAL THERAPY, LLP
Entity type:Organization
Organization Name:BRONX PHYSICAL THERAPY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-904-9581
Mailing Address - Street 1:3611 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2009
Mailing Address - Country:US
Mailing Address - Phone:718-904-9581
Mailing Address - Fax:718-931-0125
Practice Address - Street 1:3611 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2009
Practice Address - Country:US
Practice Address - Phone:718-904-9581
Practice Address - Fax:718-931-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006745-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8450289OtherAETNA PPO GROUP#
NYCM3831OtherRAILROAD MEDICARE GROUP#
NY7870OtherAETNA HMO #
NY0021702OtherAETNA ORTHONET ID#
NY21701OtherORTHONET ID#
NY0021702OtherAETNA ORTHONET ID#
NY8450289OtherAETNA PPO GROUP#
NYQ0W412Medicare ID - Type UnspecifiedMEDICARE GROUP #