Provider Demographics
NPI:1982810636
Name:ING, MICHAEL LAWRENCE (PT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:ING
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 1:162 W 56TH ST
Mailing Address - Street 2:STE. 204
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019
Mailing Address - Country:US
Mailing Address - Phone:212-307-6570
Mailing Address - Fax:212-307-6577
Practice Address - Street 1:162 W 56TH ST
Practice Address - Street 2:STE. 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-307-6570
Practice Address - Fax:212-307-6577
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1939317OtherOXFORD HEALTH PLANS PIN
NY2633889OtherUNITED HEALTHCARE
NY2633889OtherUNITED HEALTHCARE