Provider Demographics
NPI:1528384807
Name:NOTO, PHILIP
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:NOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NORTHERN BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568
Mailing Address - Country:US
Mailing Address - Phone:215-686-3751
Mailing Address - Fax:215-686-7890
Practice Address - Street 1:NORTHERN BOULEVARD
Practice Address - Street 2:
Practice Address - City:OLD WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11568
Practice Address - Country:US
Practice Address - Phone:516-686-3751
Practice Address - Fax:215-686-7890
Is Sole Proprietor?:No
Enumeration Date:2010-04-12
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09460900208100000X
PAOS018210208100000X
NY279448-01208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ549724Medicare PIN