Healthcare Provider Details

I. General information

NPI: 1801078928
Provider Name (Legal Business Name): NICHOLAS BARTOLOTTO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 N BROADWAY
HICKSVILLE NY
11801-2920
US

IV. Provider business mailing address

81 N BROADWAY
HICKSVILLE NY
11801-2920
US

V. Phone/Fax

Practice location:
  • Phone: 516-622-9515
  • Fax: 516-622-9518
Mailing address:
  • Phone: 516-622-9515
  • Fax: 516-622-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025159
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: