Provider Demographics
NPI:1699959072
Name:TENDER LOVING CARE PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:TENDER LOVING CARE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LLAURADO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-652-3535
Mailing Address - Street 1:3555 BAINBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-1411
Mailing Address - Country:US
Mailing Address - Phone:718-652-3535
Mailing Address - Fax:718-652-2323
Practice Address - Street 1:3555 BAINBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1411
Practice Address - Country:US
Practice Address - Phone:718-652-3535
Practice Address - Fax:718-652-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM1300X, 305S00000X
NY021098-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02109862NYOther1199 NATIONAL BENEFITS FUND
NY11812222OtherCAQH
NY2859717OtherUNITED HEALTH CARE
NYP3871032OtherOXFORD HEALTH PLANS
NYQ432E1OtherBCBS
NY0190212OtherGHI
NY02294140Medicaid
NY0491365OtherHEALTHNET ORTHONET
NYQ432E1OtherBCBS