Healthcare Provider Details

I. General information

NPI: 1639161151
Provider Name (Legal Business Name): MICHAEL P OCONNOR PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 PLANDOME RD SUITE 101
MANHASSET NY
11030
US

IV. Provider business mailing address

450 PLANDOME RD SUITE 101
MANHASSET NY
11030
US

V. Phone/Fax

Practice location:
  • Phone: 516-684-3404
  • Fax: 516-684-3408
Mailing address:
  • Phone: 516-684-3404
  • Fax: 516-684-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number015072
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: