Healthcare Provider Details

I. General information

NPI: 1427184969
Provider Name (Legal Business Name): FAMILY ORTHOPAEDIC & SPORTS PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 PLANDOME RD SUITE 101
MANHASSET NY
11030-1937
US

IV. Provider business mailing address

450 PLANDOME RD SUITE 101
MANHASSET NY
11030-1937
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
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: MR. MICHAEL P O'CONNOR
Title or Position: OWNER
Credential: P.T
Phone: 516-684-3404