Provider Demographics
NPI:1629014204
Name:FOGEL, LONNIE (DPT)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:
Last Name:FOGEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4908
Mailing Address - Country:US
Mailing Address - Phone:516-470-2150
Mailing Address - Fax:516-870-1477
Practice Address - Street 1:651 OLD COUNTRY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4908
Practice Address - Country:US
Practice Address - Phone:516-470-2150
Practice Address - Fax:516-870-1477
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008710-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ562410Medicare ID - Type Unspecified