Healthcare Provider Details

I. General information

NPI: 1104739937
Provider Name (Legal Business Name): JOSEPH CHARLES KORNAHRENS JR. PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 MIDDLE COUNTRY RD
CENTEREACH NY
11720-3500
US

IV. Provider business mailing address

1500 MIDDLE COUNTRY RD
CENTEREACH NY
11720-3500
US

V. Phone/Fax

Practice location:
  • Phone: 631-543-1440
  • Fax: 631-543-1930
Mailing address:
  • Phone: 631-543-1440
  • Fax: 631-543-1930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056180
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: