Provider Demographics
NPI:1215149208
Name:WINDOR PHYSICAL THERAPY,LLP
Entity type:Organization
Organization Name:WINDOR PHYSICAL THERAPY,LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:D
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-768-0002
Mailing Address - Street 1:1502 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-5602
Mailing Address - Country:US
Mailing Address - Phone:718-768-0002
Mailing Address - Fax:718-768-6720
Practice Address - Street 1:1502 8TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5602
Practice Address - Country:US
Practice Address - Phone:718-768-0002
Practice Address - Fax:718-768-6720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020669261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020669OtherHIP
NY02546885Medicaid
NY0007457599OtherAETNA
NY281691AOtherMAGNACARE
NY839874OtherMPN EMPIRE PLAN
NY01099199OtherWORKERS COMPENSATION
NY6697876OtherGHI
NY020669OtherHORIZON
NY175564OtherELDERPLAN
NY2354169OtherUNITED HEALTH CARE
NYP3317663OtherOXFORD
NY2354169OtherUNITED HEALTH CARE