Healthcare Provider Details

I. General information

NPI: 1063343010
Provider Name (Legal Business Name): NICHOLAS ANTHONY ARTUSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

569 E MAIN ST
BAY SHORE NY
11706-8505
US

IV. Provider business mailing address

30 W LIDO PROMENADE
LINDENHURST NY
11757-6610
US

V. Phone/Fax

Practice location:
  • Phone: 631-517-3822
  • Fax:
Mailing address:
  • Phone: 631-620-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: