Healthcare Provider Details

I. General information

NPI: 1013638857
Provider Name (Legal Business Name): SKYLER MORAKKABI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON FERRY DR
SOUTH SETAUKET NY
11720-4708
US

IV. Provider business mailing address

98 CEDAR POINT DR
WEST ISLIP NY
11795-5014
US

V. Phone/Fax

Practice location:
  • Phone: 631-650-2700
  • Fax:
Mailing address:
  • Phone: 516-319-9103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number049022
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: