Provider Demographics
NPI:1033739602
Name:WANTAGH PHYSICAL THERAPY, CHIROPRACTIC & NURSE PRACTITIONER IN FAMILY
Entity Type:Organization
Organization Name:WANTAGH PHYSICAL THERAPY, CHIROPRACTIC & NURSE PRACTITIONER IN FAMILY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-320-3999
Mailing Address - Street 1:3305 JERUSALEM AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-2028
Mailing Address - Country:US
Mailing Address - Phone:516-320-3999
Mailing Address - Fax:
Practice Address - Street 1:3305 JERUSALEM AVE STE 110
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2028
Practice Address - Country:US
Practice Address - Phone:516-320-3999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty