Provider Demographics
NPI:1770520751
Name:ALBERICI, DOUGLAS ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ANTHONY
Last Name:ALBERICI
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 1:505 GRAND BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-5300
Mailing Address - Country:US
Mailing Address - Phone:631-940-9800
Mailing Address - Fax:631-940-9801
Practice Address - Street 1:505 GRAND BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5300
Practice Address - Country:US
Practice Address - Phone:631-940-9800
Practice Address - Fax:631-940-9801
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021665225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300029953Medicare UPIN