Provider Demographics
NPI:1093892788
Name:PHYSICAL THERAPY LONG ISLAND, P.C.
Entity Type:Organization
Organization Name:PHYSICAL THERAPY LONG ISLAND, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NICI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-682-0466
Mailing Address - Street 1:65 FROEHLICH FARM BLVD STE 73
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2926
Mailing Address - Country:US
Mailing Address - Phone:516-682-0466
Mailing Address - Fax:516-682-0465
Practice Address - Street 1:65 FROEHLICH FARM BLVD STE 73
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2926
Practice Address - Country:US
Practice Address - Phone:516-682-0466
Practice Address - Fax:516-682-0465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8355-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQBW201Medicare ID - Type UnspecifiedPHYSICAL THERAPY