Provider Demographics
NPI:1629255989
Name:EAST ISLIP PHYSICAL THERAPY AND REHABILITATION PC
Entity Type:Organization
Organization Name:EAST ISLIP PHYSICAL THERAPY AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:MANGIONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-581-7707
Mailing Address - Street 1:126 E MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2600
Mailing Address - Country:US
Mailing Address - Phone:631-581-7707
Mailing Address - Fax:631-581-0049
Practice Address - Street 1:126 E MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2600
Practice Address - Country:US
Practice Address - Phone:631-581-7707
Practice Address - Fax:631-581-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty