Provider Demographics
NPI:1790288546
Name:NUNZIATO, DYAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:DYAN
Middle Name:
Last Name:NUNZIATO
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:DYAN
Other - Middle Name:
Other - Last Name:HERTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:49 CALVERT AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-5917
Mailing Address - Country:US
Mailing Address - Phone:631-748-0533
Mailing Address - Fax:
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:663-163-1963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032780-1225100000X
032780-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist