Healthcare Provider Details

I. General information

NPI: 1235103821
Provider Name (Legal Business Name): ALBERT SAGNELLA MAPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 1ST AVE
MORICHES NY
11955-1001
US

IV. Provider business mailing address

PO BOX 492
CENTER MORICHES NY
11934-0492
US

V. Phone/Fax

Practice location:
  • Phone: 631-566-2793
  • Fax: 631-320-0932
Mailing address:
  • Phone: 631-566-2793
  • Fax: 631-320-0932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: