Healthcare Provider Details

I. General information

NPI: 1598130056
Provider Name (Legal Business Name): ISLAND JOINTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 12/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 GRAYLEY PL
HUNTINGTN STA NY
11746-3111
US

IV. Provider business mailing address

13 GRAYLEY PL
HUNTINGTN STA NY
11746-3111
US

V. Phone/Fax

Practice location:
  • Phone: 631-489-5090
  • Fax:
Mailing address:
  • Phone: 631-489-5090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KEVIN PUSTAY
Title or Position: PRESIDENT
Credential:
Phone: 631-489-5090