| NPI |
1285095661 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
| Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Employer Identification Number EIN |
|
The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified. |
| Provider Organization Name Legal Business Name |
BRIERWOOD PHYSICAL THERAPY, P.C. |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
| Provider First Line Business Practice Location Address |
3040 AMSDELL RD |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Provider Second Line Business Practice Location Address |
SUITE 207 B |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
| Provider Business Practice Location Address City Name |
HAMBURG |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Provider Business Practice Location Address State Name |
NY |
The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider Business Practice Location Address Postal Code |
140755835 |
The first name of the provider, if the provider
is an individual. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
7166490444 |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address Fax Number |
7166490420 |
The fax number associated with the location
address of the provider being identified. |
| Provider Enumeration Date |
3/14/2016 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Last Update Date |
3/14/2016 |
The date that a record was last updated or changed. |
| Authorized Official Last Name |
STERLACE |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Authorized Official First Name |
ANTHONY |
The first name of the authorized official. |
| Authorized Official Middle Name |
JOSEPH |
The middle name of the authorized official. |
| Authorized Official Title or Position |
PHYSICAL THERAPIST |
The country code in the location address of the provider being identified. |
| Authorized Official Telephone Number |
7166490444 |
The 10-position telephone number of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
225100000X |
The fax number associated with the location
address of the provider being identified. |
| Provider License Number 1 |
034424-1 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 1 |
NY |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
| Is Organization Subpart |
N |
|
| Authorized Official Name Prefix Text |
DR. |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Authorized Official Name Suffix Text |
JR. |
|
| Authorized Official Credential Text |
P.T.,D.P.T. |
|
| Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|