Provider Demographics
NPI:1295943843
Name:SUYDAM PHYSICAL THERAPY
Entity type:Organization
Organization Name:SUYDAM PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUYDAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-771-2623
Mailing Address - Street 1:2209 MERRICK RD STE 206
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4770
Mailing Address - Country:US
Mailing Address - Phone:516-771-2623
Mailing Address - Fax:516-771-2623
Practice Address - Street 1:2209 MERRICK RD STE 206
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4770
Practice Address - Country:US
Practice Address - Phone:516-771-2623
Practice Address - Fax:516-771-2623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN