Provider Demographics
NPI:1689332272
Name:MCCOY, EILEEN (DPT)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:MCCOY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N BELLE MEAD AVE
Mailing Address - Street 2:STE A
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3530
Mailing Address - Country:US
Mailing Address - Phone:203-745-4973
Mailing Address - Fax:
Practice Address - Street 1:100 N BELLE MEAD AVE
Practice Address - Street 2:STE A
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3530
Practice Address - Country:US
Practice Address - Phone:631-689-5940
Practice Address - Fax:631-689-5943
Is Sole Proprietor?:No
Enumeration Date:2021-12-01
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist