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1100 Route 55, Suite 101, La Grangeville, NY 12540 | |
(845) 471-2423 | |
(845) 471-2776 |
Full Name | |
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Type | Facility |
Speciality | Physical Therapist |
Location | 1100 Route 55, La Grangeville, New York |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1164448049 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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225100000X | Physical Therapist | 016283-1 (New York) | Secondary |
225100000X | Physical Therapist | 018803-1 (New York) | Primary |
Provider Name | John E Burk |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1154419216 PECOS PAC ID: 2163588310 Enrollment ID: I20111020000512 |
Provider Name | Frederick J Dibernardo |
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Provider Type | Practitioner - Physical Therapist In Private Practice |
Provider Identifiers | NPI Number: 1861580938 PECOS PAC ID: 9436215688 Enrollment ID: I20111109000146 |
Mailing Address | Practice Location Address |
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1100 Route 55, Suite 101, La Grangeville, NY 12540 Ph: (845) 471-2423 | 1100 Route 55, Suite 101, La Grangeville, NY 12540 Ph: (845) 471-2423 |