Provider Demographics
NPI:1265582019
Name:WESTON PAXXON PT OT SLP PLLC
Entity type:Organization
Organization Name:WESTON PAXXON PT OT SLP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERKLEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:631-467-3700
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:610-991-2034
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:3718 HENRY HUDSON PKWY # 3726
Practice Address - Street 2:SUITE 1005
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1502
Practice Address - Country:US
Practice Address - Phone:718-432-1618
Practice Address - Fax:718-432-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ7W6U1Medicare PIN