Provider Demographics
NPI:1003220435
Name:SOUTH SHORE INTEGRATED PHYSICAL THERAPY, ACUPUNCTURE AND MASSAGE PLLC
Entity Type:Organization
Organization Name:SOUTH SHORE INTEGRATED PHYSICAL THERAPY, ACUPUNCTURE AND MASSAGE PLLC
Other - Org Name:SOUTH SHORE INTEGRATED THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:O
Authorized Official - Last Name:DINSAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-770-3127
Mailing Address - Street 1:718 LONG ISLAND AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-4230
Mailing Address - Country:US
Mailing Address - Phone:631-242-1818
Mailing Address - Fax:631-242-1506
Practice Address - Street 1:718 LONG ISLAND AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-4230
Practice Address - Country:US
Practice Address - Phone:631-242-1818
Practice Address - Fax:631-242-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022171225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty