Healthcare Provider Details

I. General information

NPI: 1942705058
Provider Name (Legal Business Name): SYOSSET PHYSICAL THERAPY AND ATHLETIC TRAINING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 EILEEN WAY
SYOSSET NY
11791-5325
US

IV. Provider business mailing address

11 N NANCY PL
MASSAPEQUA NY
11758-1912
US

V. Phone/Fax

Practice location:
  • Phone: 631-741-4653
  • Fax:
Mailing address:
  • Phone: 631-741-4653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN J BIANCHINI
Title or Position: DOCTOR OF PHYSICAL THERAPY
Credential: DPT CSCS
Phone: 631-741-4653