1518471408 NPI number — INTEGRATIVE PHYSICAL THERAPY OF LONG ISLAND, PLLC

Table of content: (NPI 1518471408)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518471408 NPI number — INTEGRATIVE PHYSICAL THERAPY OF LONG ISLAND, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATIVE PHYSICAL THERAPY OF LONG ISLAND, PLLC
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:
1518471408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 GREENE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAYVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11782-3006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-589-1628
Provider Business Mailing Address Fax Number:
631-589-1232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2171 JERICHO TPKE STE 135
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMMACK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11725-2947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-636-0300
Provider Business Practice Location Address Fax Number:
631-589-1232
Provider Enumeration Date:
11/30/2017

Additional Information

Authorized Official

Authorized Official Last Name:
KOSTER
Authorized Official First Name:
SUZANNE
Authorized Official Middle Name:
MICHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
631-636-0300

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  030696-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com