Provider Demographics
NPI:1235350505
Name:ST. JAMES PLAZA
Entity Type:Organization
Organization Name:ST. JAMES PLAZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSGRIFF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-862-8990
Mailing Address - Street 1:21 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3432
Mailing Address - Country:US
Mailing Address - Phone:631-724-5325
Mailing Address - Fax:
Practice Address - Street 1:273 MORICHES RD
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2117
Practice Address - Country:US
Practice Address - Phone:631-862-8990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015167261QP2000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility