Provider Demographics
NPI:1275584427
Name:VAN RIEL, ERWIN (PT)
Entity Type:Individual
Prefix:MR
First Name:ERWIN
Middle Name:
Last Name:VAN RIEL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 SMITHTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1849
Mailing Address - Country:US
Mailing Address - Phone:631-863-1290
Mailing Address - Fax:631-863-3090
Practice Address - Street 1:197 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1849
Practice Address - Country:US
Practice Address - Phone:631-863-1290
Practice Address - Fax:631-863-3090
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022682225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ03M11Medicare PIN