Provider Demographics
NPI:1164872669
Name:ILLARI PHYSCIAL THERAPY P.C.
Entity Type:Organization
Organization Name:ILLARI PHYSCIAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ILLARI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-252-1512
Mailing Address - Street 1:51 CLEREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1708
Mailing Address - Country:US
Mailing Address - Phone:631-447-2315
Mailing Address - Fax:631-447-2297
Practice Address - Street 1:2314 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2915
Practice Address - Country:US
Practice Address - Phone:631-438-0400
Practice Address - Fax:631-438-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018220261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy