Healthcare Provider Details

I. General information

NPI: 1336650209
Provider Name (Legal Business Name): STEVEN ANTHONY VENEGAS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2017
Last Update Date: 10/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 FRANKLIN AVE LOWER LEVEL SUITE 105
GARDEN CITY NY
11530
US

IV. Provider business mailing address

7311 4TH AVE APT B1
BROOKLYN NY
11209-2534
US

V. Phone/Fax

Practice location:
  • Phone: 516-280-8811
  • Fax:
Mailing address:
  • Phone: 516-244-3443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number033525
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number033525
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: