Provider Demographics
NPI:1376842658
Name:FARMINGDALE PHYSICAL THERAPY EAST LLC
Entity Type:Organization
Organization Name:FARMINGDALE PHYSICAL THERAPY EAST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT OCS NCS GCS
Authorized Official - Phone:516-293-0565
Mailing Address - Street 1:326 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3507
Mailing Address - Country:US
Mailing Address - Phone:516-293-0565
Mailing Address - Fax:516-293-1897
Practice Address - Street 1:326 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3507
Practice Address - Country:US
Practice Address - Phone:516-293-0565
Practice Address - Fax:516-293-1897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006358-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty