Provider Demographics
| NPI: | 1952465338 |
|---|---|
| Name: | PELHAM PHYSICAL MEDICINE INC |
| Entity type: | Organization |
| Organization Name: | PELHAM PHYSICAL MEDICINE INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | ALLAN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PERLMUTTER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 718-823-3900 |
| Mailing Address - Street 1: | 2118 WILLIAMSBRIDGE RD |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BRONX |
| Mailing Address - State: | NY |
| Mailing Address - Zip Code: | 10461-1602 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 718-823-3900 |
| Mailing Address - Fax: | 718-823-3961 |
| Practice Address - Street 1: | 2118 WILLIAMSBRIDGE RD |
| Practice Address - Street 2: | |
| Practice Address - City: | BRONX |
| Practice Address - State: | NY |
| Practice Address - Zip Code: | 10461-1602 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 718-823-3900 |
| Practice Address - Fax: | 718-823-3961 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-12-20 |
| Last Update Date: | 2025-03-06 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 225100000X, 261QR0400X, 208100000X, 343900000X, 213E00000X | ||
| NY | 165628 | 103TP0016X, 103TM1800X |
| NY | 076899 | 1041C0700X |
| NY | 076899-1 | 106H00000X |
| NY | F335470 | 176B00000X |
| NY | 167018-1 | 207R00000X |
| NY | R029782 | 251B00000X |
| NY | 041-0-100 | 251K00000X |
| NY | 189920-1 | 261QP2000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation | Group - Multi-Specialty |
| Yes | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 103TP0016X | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) | Group - Multi-Specialty |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 176B00000X | Other Service Providers | Midwife | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 251B00000X | Agencies | Case Management | ||
| No | 251K00000X | Agencies | Public Health or Welfare | ||
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | |
| No | 343900000X | Transportation Services | Non-emergency Medical Transport (VAN) | ||
| No | 213E00000X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NY | 02382052 | Medicaid | |
| NY | 171001539 | Medicaid | |
| NY | 1962639079 | Medicaid | |
| NY | 1144262510 | Medicare ID - Type Unspecified |
