Provider Demographics
NPI:1538192067
Name:RIVERDALE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:RIVERDALE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-884-0444
Mailing Address - Street 1:2735 HENRY HUDSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4701
Mailing Address - Country:US
Mailing Address - Phone:718-884-0444
Mailing Address - Fax:718-549-0145
Practice Address - Street 1:2735 HENRY HUDSON PKWY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4701
Practice Address - Country:US
Practice Address - Phone:718-884-0444
Practice Address - Fax:718-549-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0025501OtherORTHONET HEALTHNET
NYM4252POtherHIP
NY0030977OtherGHI
NY90478OtherAETNA
NY25501OtherORTHONET CIGNA
NY4C8041OtherHEALTHNET
NYQ10492OtherBLUE CROSS
NY0025501OtherORTHONET AETNA
NY000305900101OtherHEALTHPLUS
NY001395A81OtherHEALTHFIRST
NYGS016OtherOXFORD
NY000000058810OtherGHI HMO
NY001395A81OtherHEALTHFIRST