Provider Demographics
NPI:1598015158
Name:RITIENI, ANGELA (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:
Last Name:RITIENI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 OLD TOWN RD
Mailing Address - Street 2:BLG 3, APT. E
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2200
Mailing Address - Country:US
Mailing Address - Phone:516-770-8656
Mailing Address - Fax:516-770-8656
Practice Address - Street 1:41 ECHO AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-2108
Practice Address - Country:US
Practice Address - Phone:631-331-2348
Practice Address - Fax:631-928-7068
Is Sole Proprietor?:No
Enumeration Date:2012-09-11
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017935-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist