Healthcare Provider Details

I. General information

NPI: 1992302202
Provider Name (Legal Business Name): PAUL ALAN O ERGINA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 KNICKERBOCKER RD N
PLAINVIEW NY
11803-2627
US

IV. Provider business mailing address

PO BOX 478
HICKSVILLE NY
11802-0478
US

V. Phone/Fax

Practice location:
  • Phone: 516-532-2574
  • Fax:
Mailing address:
  • Phone: 516-532-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number010067-01
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: