Healthcare Provider Details

I. General information

NPI: 1487376182
Provider Name (Legal Business Name): ERIC DEUTSCH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 TECHNOLOGY DR
EAST SETAUKET NY
11733-4064
US

IV. Provider business mailing address

502 LAKE DR
MEDFORD NY
11763-4608
US

V. Phone/Fax

Practice location:
  • Phone: 631-751-8000
  • Fax:
Mailing address:
  • Phone: 631-921-3210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number049260
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: