Provider Demographics
NPI:1164697801
Name:NASSAU SPORTS PHYSICAL THERAPY OF HUNTINGTON PC
Entity Type:Organization
Organization Name:NASSAU SPORTS PHYSICAL THERAPY OF HUNTINGTON PC
Other - Org Name:MICHAEL H GALLAGHER PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:H
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-385-1155
Mailing Address - Street 1:200 W CARVER ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3303
Mailing Address - Country:US
Mailing Address - Phone:631-385-1155
Mailing Address - Fax:631-385-0813
Practice Address - Street 1:200 W CARVER ST
Practice Address - Street 2:SUITE 4
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3303
Practice Address - Country:US
Practice Address - Phone:631-385-1155
Practice Address - Fax:631-385-0813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009165-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXQQP1Medicare PIN