Provider Demographics
NPI:1306200498
Name:DRAGHI, ANDREW R (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:DRAGHI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CRYSTAL BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11955-1909
Mailing Address - Country:US
Mailing Address - Phone:631-833-4353
Mailing Address - Fax:
Practice Address - Street 1:630 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3725
Practice Address - Country:US
Practice Address - Phone:631-833-4353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039737225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist