Healthcare Provider Details

I. General information

NPI: 1922003151
Provider Name (Legal Business Name): ALYSA LONGO MA, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSA DREISHPOON PT

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 04/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 TOMPKINS AVE
PLEASANTVILLE NY
10570-3144
US

IV. Provider business mailing address

333 EARLE OVINGTON BLVD SUITE 225
UNIONDALE NY
11553-3610
US

V. Phone/Fax

Practice location:
  • Phone: 914-495-3655
  • Fax:
Mailing address:
  • Phone: 516-321-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number010661
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: