Provider Demographics
NPI:1134881428
Name:WYCKOFF, JAMES WILLIAM (LMT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:WYCKOFF
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:WILLIAM
Other - Last Name:WYCKOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4 MEADOWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3829
Mailing Address - Country:US
Mailing Address - Phone:631-214-6024
Mailing Address - Fax:
Practice Address - Street 1:1930 VETERANS HWY STE 15
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1599
Practice Address - Country:US
Practice Address - Phone:631-214-6024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist