NPIMap

Organization Active NPI

Deer Park Physical Therapy and Chiropractic PLLC

  • Physical Therapist
  • Deer Park, NY
National Provider Identifier
1841608841
Registry record updated May 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
021022-1 Issued in NY
Legal business name
DEER PARK PHYSICAL THERAPY AND CHIROPRACTIC PLLC
Practice address
2103 Deer Park Ave
Deer Park, NY 11729-1319
Phone
(631) 242-4500
Fax
(631) 242-0885
NPI assigned
Jul 23, 2014
Last updated
May 13, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ronald Joseph Bredow, MS, PT
Title
Owner, Physical Therapist
Phone
(631) 242-4500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 021022-1 NY Primary

Addresses

Primary practice location

2103 Deer Park Ave
Deer Park, NY 11729-1319

Mailing address

2103 Deer Park Ave
Deer Park, NY 11729-1319
Phone (631) 242-4500

Other identifiers 5

IdentifierTypeStateIssuer
771360POtherHIP
0401575OtherCIGNA
6697450OtherGHI
P3369855OtherNYOXFORD
Q13V53OtherNYBCBS

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1431475200000",
    "number": "1841608841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2103 DEER PARK AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117291319",
            "telephone_number": "631-242-4500",
            "fax_number": "631-242-0885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 DEER PARK AVE",
            "city": "DEER PARK",
            "state": "NY",
            "postal_code": "117291319",
            "telephone_number": "631-242-4500",
            "fax_number": "631-242-0885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER PARK PHYSICAL THERAPY AND CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-23",
        "last_updated": "2015-05-13",
        "status": "A",
        "authorized_official_last_name": "BREDOW",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER, PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "631-242-4500",
        "authorized_official_credential": "MS, PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "021022-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "771360P",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "0401575",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "6697450",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P3369855",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Q13V53",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deer Park, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.