Provider Demographics
NPI:1194727842
Name:WINGET, JOHN M (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M
Last Name:WINGET
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAWTHORNE
Mailing Address - State:NY
Mailing Address - Zip Code:10532-1142
Mailing Address - Country:US
Mailing Address - Phone:914-773-2145
Mailing Address - Fax:914-773-2147
Practice Address - Street 1:153 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-1142
Practice Address - Country:US
Practice Address - Phone:914-773-2145
Practice Address - Fax:914-773-2147
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2016-02-10
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NY006015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ53872Medicare ID - Type Unspecified