Provider Demographics
NPI:1235103821
Name:SAGNELLA, ALBERT (MAPT)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:SAGNELLA
Suffix:
Gender:M
Credentials:MAPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 492
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-0492
Mailing Address - Country:US
Mailing Address - Phone:631-566-2793
Mailing Address - Fax:631-320-0932
Practice Address - Street 1:11 1ST AVE
Practice Address - Street 2:
Practice Address - City:MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11955-1001
Practice Address - Country:US
Practice Address - Phone:631-566-2793
Practice Address - Fax:631-320-0932
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012491225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY27401OtherORTHONET CIGNA
NY6600588OtherGHI
NY27401OtherORTHONET CIGNA