Provider Demographics
NPI:1720295975
Name:ISLAND REHAB & SPORTS PT PC
Entity Type:Organization
Organization Name:ISLAND REHAB & SPORTS PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWANDOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-223-2713
Mailing Address - Street 1:9 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3002
Mailing Address - Country:US
Mailing Address - Phone:631-223-2713
Mailing Address - Fax:631-223-2713
Practice Address - Street 1:9 BIRCH DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3002
Practice Address - Country:US
Practice Address - Phone:631-223-2713
Practice Address - Fax:631-223-2713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN
NY=========OtherEIN