Healthcare Provider Details

I. General information

NPI: 1952063414
Provider Name (Legal Business Name): JOSEPH MICHAEL SILLUZIO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-2249
US

IV. Provider business mailing address

7510 SAINT JOSEPH RD
NIAGARA FALLS NY
14304-1347
US

V. Phone/Fax

Practice location:
  • Phone: 716-773-4323
  • Fax:
Mailing address:
  • Phone: 716-579-5875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number012099-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: