Provider Demographics
NPI:1639109770
Name:ISLAND SPORTS PHYSICAL THERAPY OF SMITHTOWN, P.C.
Entity Type:Organization
Organization Name:ISLAND SPORTS PHYSICAL THERAPY OF SMITHTOWN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-462-9595
Mailing Address - Street 1:176 SMITHTOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1859
Mailing Address - Country:US
Mailing Address - Phone:631-979-5900
Mailing Address - Fax:631-979-5908
Practice Address - Street 1:176 SMITHTOWN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1859
Practice Address - Country:US
Practice Address - Phone:631-979-5900
Practice Address - Fax:631-979-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ0WLL1Medicare PIN