Provider Demographics
NPI:1891265625
Name:FAY, CONNOR TILLAPAUGH (DPT)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:TILLAPAUGH
Last Name:FAY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4517 28TH AVE APT 2R
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1112
Mailing Address - Country:US
Mailing Address - Phone:315-263-6603
Mailing Address - Fax:
Practice Address - Street 1:370 LEXINGTON AVE STE 2300
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6503
Practice Address - Country:US
Practice Address - Phone:646-885-6605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0383502251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic