Provider Demographics
NPI:1821273301
Name:ROBERT WILUTIS OCCUPATIONAL AND PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:ROBERT WILUTIS OCCUPATIONAL AND PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:WILUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR CHT
Authorized Official - Phone:631-331-3608
Mailing Address - Street 1:635 BELLE TERRE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777
Mailing Address - Country:US
Mailing Address - Phone:631-331-3608
Mailing Address - Fax:631-331-2392
Practice Address - Street 1:1733 A NORTH OCEAN AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763
Practice Address - Country:US
Practice Address - Phone:631-331-3608
Practice Address - Fax:631-331-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008737332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4823760004Medicare NSC
NYQRW801Medicare UPIN