Provider Demographics
NPI:1366482408
Name:ISLAND SPORTS PHYSIOTHERAPY, PC
Entity Type:Organization
Organization Name:ISLAND SPORTS PHYSIOTHERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-462-9595
Mailing Address - Street 1:1937 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-6208
Mailing Address - Country:US
Mailing Address - Phone:631-462-9595
Mailing Address - Fax:631-462-9613
Practice Address - Street 1:1937 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-6208
Practice Address - Country:US
Practice Address - Phone:631-462-9595
Practice Address - Fax:631-462-9613
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISLAND SPORTS PHYSIOTHERAPY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0WGZ1Medicare PIN