Provider Demographics
NPI:1538222740
Name:ADVANTAGE P M & R LLC
Entity type:Organization
Organization Name:ADVANTAGE P M & R LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:VINCENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-344-4477
Mailing Address - Street 1:60 DUNNING RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2215
Mailing Address - Country:US
Mailing Address - Phone:845-344-4477
Mailing Address - Fax:845-344-6072
Practice Address - Street 1:60 DUNNING RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-344-4477
Practice Address - Fax:845-344-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2175981208100000X
NY19284622081P2900X
NY20050212081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01575286Medicaid
NY02088562Medicaid
NY02688757Medicaid
NY02088562Medicaid
NYH19235Medicare UPIN
NY65G431Medicare ID - Type Unspecified
NY02688757Medicaid
NY01575286Medicaid
F73199Medicare UPIN