Provider Demographics
NPI:1871783779
Name:JWG PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:JWG PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-656-4824
Mailing Address - Street 1:1 SCHOOL ST
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2545
Mailing Address - Country:US
Mailing Address - Phone:516-656-4824
Mailing Address - Fax:516-656-4833
Practice Address - Street 1:1 SCHOOL ST
Practice Address - Street 2:SUITE 105A
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2545
Practice Address - Country:US
Practice Address - Phone:516-656-4824
Practice Address - Fax:516-656-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY136840OtherVYTRA PROVIDER NUMBER
NY2904019OtherAETNA PPO PROVIDER NUMBER
NY58958POtherHIP PROVIDER NUMBER
NYP2720801OtherOXFORD PROVIDER NUMBER
NY100206834602OtherUNITED HEALTHCARE-MEDICAI
NY0026201OtherCIGNA
600934000OtherDEPARTMENT OF LABOR
NY273729Other1199 PROVIDER NUMBER
NY5C7048OtherHEALTHNET PROVIDER NUMBER
NY6605247OtherGHI PROVIDER NUMBER
NY7004397OtherAETNA HMO PROVIDER NUMBER
NYQN6301OtherEMPIRE PROVIDER NUMBER
NY58958POtherHIP PROVIDER NUMBER
NY136840OtherVYTRA PROVIDER NUMBER