Provider Demographics
NPI:1376741629
Name:ALL-STAR PHYSICAL THERAPY,PC
Entity Type:Organization
Organization Name:ALL-STAR PHYSICAL THERAPY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:516-364-6720
Mailing Address - Street 1:567 JERICHO TPKE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4505
Mailing Address - Country:US
Mailing Address - Phone:516-364-6720
Mailing Address - Fax:516-364-6722
Practice Address - Street 1:567 JERICHO TPKE
Practice Address - Street 2:SUITE 202
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4505
Practice Address - Country:US
Practice Address - Phone:516-364-6720
Practice Address - Fax:516-364-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-09
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020985261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ2WXS1Medicare PIN