Provider Demographics
NPI:1184788770
Name:ISLAND THERAPY FITNESS CENTER, LLC
Entity type:Organization
Organization Name:ISLAND THERAPY FITNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAURO
Authorized Official - Middle Name:
Authorized Official - Last Name:CATALETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-248-4488
Mailing Address - Street 1:200 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 470
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4235
Mailing Address - Country:US
Mailing Address - Phone:516-248-4488
Mailing Address - Fax:516-248-1727
Practice Address - Street 1:200 OLD COUNTRY RD
Practice Address - Street 2:SUITE 470
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4235
Practice Address - Country:US
Practice Address - Phone:516-248-4488
Practice Address - Fax:516-248-1727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149148332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1246850001Medicare ID - Type Unspecified