Provider Demographics
NPI:1124023478
Name:SROKA, PIOTR (PT)
Entity Type:Individual
Prefix:MR
First Name:PIOTR
Middle Name:
Last Name:SROKA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 IMPERIAL DR
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-3222
Mailing Address - Country:US
Mailing Address - Phone:631-476-7686
Mailing Address - Fax:631-821-3462
Practice Address - Street 1:517 OAK ST
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-3244
Practice Address - Country:US
Practice Address - Phone:631-789-3789
Practice Address - Fax:631-789-3728
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02020175Medicaid
NYQ31391OtherBLUECROSS BLUESHIELD-MP
NY6604263OtherGHI
NYAZ00952OtherMDNY
NYQ31392OtherBLUE CROSS BLUE SHIELD
NY819836OtherMPN
NY013642OtherHIP
NY195036OtherUNITED HEALTHCARE
NYA2517394OtherOXFORD
NYQ31392Medicare ID - Type Unspecified
NYA2517394OtherOXFORD
NYQ31392OtherBLUE CROSS BLUE SHIELD