Healthcare Provider Details

I. General information

NPI: 1184735268
Provider Name (Legal Business Name): ALL STAR PHYSICAL THERAPY AND REHABILITION P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MEMORIAL BLVD
EAST MORICHES NY
11940-1436
US

IV. Provider business mailing address

16 MEMORIAL BLVD
EAST MORICHES NY
11940-1436
US

V. Phone/Fax

Practice location:
  • Phone: 631-525-6828
  • Fax:
Mailing address:
  • Phone: 631-525-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number022570
License Number StateNY

VIII. Authorized Official

Name: PETER MICHAEL FISCINA
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 631-525-6828