Healthcare Provider Details

I. General information

NPI: 1730210592
Provider Name (Legal Business Name): PALERMO PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 JERICHO TPKE SUITE 305
JERICHO NY
11753-1073
US

IV. Provider business mailing address

99 JERICHO TPKE STE 100
JERICHO NY
11753-1015
US

V. Phone/Fax

Practice location:
  • Phone: 516-280-8044
  • Fax: 516-280-8045
Mailing address:
  • Phone: 516-280-8044
  • Fax: 516-280-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0257731
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MARCO LUIGI PALERMO
Title or Position: DIRECTOR OWNER
Credential: DPT
Phone: 516-280-8044