Provider Demographics
NPI:1326464710
Name:HANSEN, WILLIAM H
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:HANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PEACHTREE CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4616
Mailing Address - Country:US
Mailing Address - Phone:631-467-3700
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:4089 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:S SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1260
Practice Address - Country:US
Practice Address - Phone:631-331-1988
Practice Address - Fax:631-331-1988
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2015-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400105628Medicare PIN