Provider Demographics
NPI:1245346378
Name:EGAN, JAMES J (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:J
Last Name:EGAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758
Mailing Address - Country:US
Mailing Address - Phone:516-730-2222
Mailing Address - Fax:516-730-2244
Practice Address - Street 1:660 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758
Practice Address - Country:US
Practice Address - Phone:516-730-2222
Practice Address - Fax:516-730-2244
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015912225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
QQ4111OtherBCBS
1381124OtherUNITED HEALTHCARE
9657114OtherGROUP HEALTH INCORPERATED
015912SOtherHEALTHCARE PARTNER
9657114OtherGROUP HEALTH INCORPERATED