Provider Demographics
NPI:1194865329
Name:LONG ISLAND ORTHOPAEDIC & SPORTS, P.T.
Entity Type:Organization
Organization Name:LONG ISLAND ORTHOPAEDIC & SPORTS, P.T.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:BESSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-327-3959
Mailing Address - Street 1:2001 MARCUS AVE
Mailing Address - Street 2:SUITE 95W
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1011
Mailing Address - Country:US
Mailing Address - Phone:516-327-3959
Mailing Address - Fax:516-327-3979
Practice Address - Street 1:2001 MARCUS AVE
Practice Address - Street 2:SUITE 95W
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1011
Practice Address - Country:US
Practice Address - Phone:516-327-3959
Practice Address - Fax:516-327-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQBW842Medicare ID - Type Unspecified