Provider Demographics
NPI:1558415711
Name:FRANK KERSHIS PT PC
Entity Type:Organization
Organization Name:FRANK KERSHIS PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KERSHIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-476-4880
Mailing Address - Street 1:1010 ROUTE 112
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3097
Mailing Address - Country:US
Mailing Address - Phone:631-476-4880
Mailing Address - Fax:631-476-4887
Practice Address - Street 1:1010 ROUTE 112
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3097
Practice Address - Country:US
Practice Address - Phone:631-476-4880
Practice Address - Fax:631-476-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01570-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL4281Medicare ID - Type Unspecified