Provider Demographics
NPI:1487639993
Name:NYCONN ORTHOPAEDIC & REHABILITATION SPECIALISTS, PLLC
Entity type:Organization
Organization Name:NYCONN ORTHOPAEDIC & REHABILITATION SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LUBBE
Authorized Official - Suffix:
Authorized Official - Credentials:BSCPHYSHONS
Authorized Official - Phone:845-279-5550
Mailing Address - Street 1:8 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:WACCABUC
Mailing Address - State:NY
Mailing Address - Zip Code:10597-1013
Mailing Address - Country:US
Mailing Address - Phone:914-763-0068
Mailing Address - Fax:
Practice Address - Street 1:667 STONELEIGH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-2454
Practice Address - Country:US
Practice Address - Phone:914-279-5550
Practice Address - Fax:914-279-3490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009815-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty