Provider Demographics
NPI:1013243948
Name:PINNACLE PHYSICAL MEDICINE AND REHABILITATION, PC
Entity Type:Organization
Organization Name:PINNACLE PHYSICAL MEDICINE AND REHABILITATION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFANDIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-422-5371
Mailing Address - Street 1:1175 MONTAUK HWY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4939
Mailing Address - Country:US
Mailing Address - Phone:631-422-5371
Mailing Address - Fax:631-893-8012
Practice Address - Street 1:1175 MONTAUK HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4939
Practice Address - Country:US
Practice Address - Phone:631-422-5371
Practice Address - Fax:631-893-8012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249030208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty