Provider Demographics
NPI:1295911071
Name:ISLAND SHORE PHYSICAL THERAPY, LLP
Entity type:Organization
Organization Name:ISLAND SHORE PHYSICAL THERAPY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-277-9283
Mailing Address - Street 1:174 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2633
Mailing Address - Country:US
Mailing Address - Phone:631-277-9283
Mailing Address - Fax:631-277-9394
Practice Address - Street 1:250 HIGBIE LN
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-2828
Practice Address - Country:US
Practice Address - Phone:631-277-9321
Practice Address - Fax:631-277-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4142-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy