Healthcare Provider Details

I. General information

NPI: 1124023478
Provider Name (Legal Business Name): PIOTR SROKA P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 OAK ST
COPIAGUE NY
11726-3244
US

IV. Provider business mailing address

36 IMPERIAL DR
MILLER PLACE NY
11764-3222
US

V. Phone/Fax

Practice location:
  • Phone: 631-789-3789
  • Fax: 631-789-3728
Mailing address:
  • Phone: 631-476-7686
  • Fax: 631-821-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number013642
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: