Provider Demographics
NPI:1245379759
Name:LONG ISLAND PEDIATRIC PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:LONG ISLAND PEDIATRIC PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-358-9146
Mailing Address - Street 1:99 TULIP AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-1974
Mailing Address - Country:US
Mailing Address - Phone:516-358-9146
Mailing Address - Fax:
Practice Address - Street 1:99 TULIP AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-1974
Practice Address - Country:US
Practice Address - Phone:516-358-9146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty