Provider Demographics
NPI:1326131392
Name:NORTH ISLAND PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:NORTH ISLAND PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MA, PT
Authorized Official - Phone:631-751-7988
Mailing Address - Street 1:2500 NESCONSET HWY.
Mailing Address - Street 2:BLDG. 22B
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-751-7988
Mailing Address - Fax:631-751-7989
Practice Address - Street 1:2500 NESCONSET HWY.
Practice Address - Street 2:BLDG. 22B
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-751-7988
Practice Address - Fax:631-751-7989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0167201174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNI0Q3W1R10Medicare ID - Type Unspecified