Provider Demographics
NPI:1437196706
Name:PINOY PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:PINOY PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BOGNAY
Authorized Official - Middle Name:DURY
Authorized Official - Last Name:DOMANAS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE PT
Authorized Official - Phone:718-426-9595
Mailing Address - Street 1:4024 82ND ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1305
Mailing Address - Country:US
Mailing Address - Phone:718-426-9595
Mailing Address - Fax:718-426-2729
Practice Address - Street 1:4024 82ND ST FL 2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1305
Practice Address - Country:US
Practice Address - Phone:718-426-9595
Practice Address - Fax:718-426-2729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0259211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02692708Medicaid
NY06946Medicare ID - Type UnspecifiedPHYSICAL THERIPST