Provider Demographics
NPI:1427184969
Name:FAMILY ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:FAMILY ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-684-3404
Mailing Address - Street 1:450 PLANDOME RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1937
Mailing Address - Country:US
Mailing Address - Phone:516-684-3404
Mailing Address - Fax:516-684-3408
Practice Address - Street 1:450 PLANDOME RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1937
Practice Address - Country:US
Practice Address - Phone:516-684-3404
Practice Address - Fax:516-684-3408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015072261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQAWLL1Medicare PIN
NYQQ8261Medicare PIN