Provider Demographics
NPI:1790890622
Name:LONG ISLAND BALANCE AND VESTIBULAR PT
Entity Type:Organization
Organization Name:LONG ISLAND BALANCE AND VESTIBULAR PT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGNA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, NCS
Authorized Official - Phone:631-724-5433
Mailing Address - Street 1:154 JACKSON AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2833
Mailing Address - Country:US
Mailing Address - Phone:631-584-3145
Mailing Address - Fax:631-724-5478
Practice Address - Street 1:732 SMITHTOWN BYP
Practice Address - Street 2:SUITE 102A
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5020
Practice Address - Country:US
Practice Address - Phone:631-724-5433
Practice Address - Fax:631-724-5478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010950-12251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Single Specialty