Provider Demographics
NPI:1851511877
Name:DUSWALT-AGOSTINO, EILEEN PATRICIA (MS P T)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:PATRICIA
Last Name:DUSWALT-AGOSTINO
Suffix:
Gender:F
Credentials:MS P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 TYBURN LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1426
Mailing Address - Country:US
Mailing Address - Phone:631-696-9222
Mailing Address - Fax:
Practice Address - Street 1:3 TECHNOLOGY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4064
Practice Address - Country:US
Practice Address - Phone:631-751-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013718-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist