1255352464 NPI number — CARLE PLACE SPORT & ORTHOPEDIC PHYSICAL THERAPY PC

Table of content: JOSEPH EARL ROBERTS JR. M.D. (NPI 1518955269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255352464 NPI number — CARLE PLACE SPORT & ORTHOPEDIC PHYSICAL THERAPY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARLE PLACE SPORT & ORTHOPEDIC PHYSICAL THERAPY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255352464
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
208 STONEHINGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARLE PLACE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11514-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-333-7771
Provider Business Mailing Address Fax Number:
516-333-3463

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 STONEHINGE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLE PLACE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11514-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-333-7771
Provider Business Practice Location Address Fax Number:
516-333-3463
Provider Enumeration Date:
07/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MADEY
Authorized Official First Name:
LES
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-333-7771

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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