Provider Demographics
NPI:1558646034
Name:CASEY-WENDELEWSKI, AILEEN MARIE (PT)
Entity Type:Individual
Prefix:MRS
First Name:AILEEN
Middle Name:MARIE
Last Name:CASEY-WENDELEWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MOUNT GREY RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1022
Mailing Address - Country:US
Mailing Address - Phone:631-848-5753
Mailing Address - Fax:
Practice Address - Street 1:10 MOUNT GREY RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1022
Practice Address - Country:US
Practice Address - Phone:631-848-5753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017582-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics