Healthcare Provider Details

I. General information

NPI: 1568439628
Provider Name (Legal Business Name): SETH BEN-YISHAY PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 IRA ROAD PROACTIVE PHYSICAL THERAPY OF SYOSSET, PLLC
SYOSSET NY
11791-3503
US

IV. Provider business mailing address

54 IRA ROAD PROACTIVE PHYSICAL THERAPY OF SYOSSET, PLLC
SYOSSET NY
11791-3503
US

V. Phone/Fax

Practice location:
  • Phone: 516-921-6464
  • Fax: 516-921-7676
Mailing address:
  • Phone: 516-921-6464
  • Fax: 516-921-7676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberNY013919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: