Healthcare Provider Details

I. General information

NPI: 1356328793
Provider Name (Legal Business Name): ANGELO ORPHANOS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 ROBBINS LN
SYOSSET NY
11791-6005
US

IV. Provider business mailing address

295 ROBBINS LN
SYOSSET NY
11791-6005
US

V. Phone/Fax

Practice location:
  • Phone: 516-888-9661
  • Fax: 212-439-1608
Mailing address:
  • Phone: 516-888-9661
  • Fax: 212-439-1608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number21291
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: