Provider Demographics
NPI:1457489379
Name:HRONCICH, MARC D (PT,DPT)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:D
Last Name:HRONCICH
Suffix:
Gender:M
Credentials:PT,DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 EAST PULASKI ROAD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1601
Mailing Address - Country:US
Mailing Address - Phone:631-673-4600
Mailing Address - Fax:631-673-4621
Practice Address - Street 1:266 EAST PULASKI ROAD
Practice Address - Street 2:SUITE 3
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1601
Practice Address - Country:US
Practice Address - Phone:631-673-4600
Practice Address - Fax:631-673-4621
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400014211Medicare PIN