Provider Demographics
NPI:1518471408
Name:INTEGRATIVE PHYSICAL THERAPY OF LONG ISLAND, PLLC
Entity Type:Organization
Organization Name:INTEGRATIVE PHYSICAL THERAPY OF LONG ISLAND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:631-636-0300
Mailing Address - Street 1:303 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-3006
Mailing Address - Country:US
Mailing Address - Phone:631-589-1628
Mailing Address - Fax:631-589-1232
Practice Address - Street 1:2171 JERICHO TPKE STE 135
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2947
Practice Address - Country:US
Practice Address - Phone:631-636-0300
Practice Address - Fax:631-589-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-30
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030696-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty