Provider Demographics
NPI:1578235743
Name:ISLAND PHYSICAL THERAPY OF EAST SETAUKET
Entity Type:Organization
Organization Name:ISLAND PHYSICAL THERAPY OF EAST SETAUKET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:631-675-1706
Mailing Address - Street 1:6 S JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2021
Mailing Address - Country:US
Mailing Address - Phone:631-675-1706
Mailing Address - Fax:631-675-1708
Practice Address - Street 1:6 S JERSEY AVE
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2021
Practice Address - Country:US
Practice Address - Phone:631-675-1706
Practice Address - Fax:631-675-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy