Healthcare Provider Details

I. General information

NPI: 1235350505
Provider Name (Legal Business Name): ST. JAMES PLAZA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 MORICHES RD
SAINT JAMES NY
11780-2117
US

IV. Provider business mailing address

21 COLONIAL RD
SMITHTOWN NY
11787-3432
US

V. Phone/Fax

Practice location:
  • Phone: 631-862-8990
  • Fax:
Mailing address:
  • Phone: 631-724-5325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number015167
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number015167
License Number StateNY

VIII. Authorized Official

Name: MR. TIMOTHY J COSGRIFF
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 631-862-8990