Provider Demographics
NPI:1366526519
Name:PERFORMANCE REHABILITATION PT PLLC
Entity type:Organization
Organization Name:PERFORMANCE REHABILITATION PT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SREBNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT CHT
Authorized Official - Phone:914-776-7310
Mailing Address - Street 1:955 YONKERS AVE
Mailing Address - Street 2:STE 109
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-3060
Mailing Address - Country:US
Mailing Address - Phone:914-776-7310
Mailing Address - Fax:914-776-7566
Practice Address - Street 1:955 YONKERS AVE
Practice Address - Street 2:STE 109
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3060
Practice Address - Country:US
Practice Address - Phone:914-776-7310
Practice Address - Fax:914-776-7566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG494708OtherOXFORD HEALTH PLAN
NE2122316OtherUNITED HEALTHCARE
NY5080104OtherAETNA PPO / POS
NY30201OtherORTHONET
NY=========OtherHORIZON
NY=========Other1199
NYG494708OtherOXFORD HEALTH PLAN
NY=========OtherHORIZON
NY=========Other1199
NYG494708OtherOXFORD HEALTH PLAN