Provider Demographics
NPI:1740360130
Name:P.T.C MEDICAL, P.C.
Entity type:Organization
Organization Name:P.T.C MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:
Authorized Official - First Name:PAOLO
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-289-0088
Mailing Address - Street 1:79 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3101
Mailing Address - Country:US
Mailing Address - Phone:631-289-0088
Mailing Address - Fax:631-289-6177
Practice Address - Street 1:79 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3101
Practice Address - Country:US
Practice Address - Phone:631-289-0088
Practice Address - Fax:631-289-6177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWZZQY1Medicare PIN