Healthcare Provider Details

I. General information

NPI: 1699729590
Provider Name (Legal Business Name): JOHN J DRAGAN P.T., GCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 MARCUS AVE SUITE M15
LAKE SUCCESS NY
11042-1013
US

IV. Provider business mailing address

223 RIDGE RD
DOUGLASTON NY
11363-1308
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-8808
  • Fax: 516-488-8818
Mailing address:
  • Phone: 516-488-8808
  • Fax: 516-488-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015842-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number8191
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: