Provider Demographics
NPI:1356328793
Name:ORPHANOS, ANGELO (PT)
Entity Type:Individual
Prefix:
First Name:ANGELO
Middle Name:
Last Name:ORPHANOS
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 1:295 ROBBINS LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6005
Mailing Address - Country:US
Mailing Address - Phone:516-888-9661
Mailing Address - Fax:212-439-1608
Practice Address - Street 1:295 ROBBINS LN
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6005
Practice Address - Country:US
Practice Address - Phone:516-888-9661
Practice Address - Fax:212-439-1608
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OSW212Medicare ID - Type Unspecified