Healthcare Provider Details

I. General information

NPI: 1851599617
Provider Name (Legal Business Name): STEPHEN A SANACORE P.T.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 WARWICK ST
UNIONDALE NY
11553
US

IV. Provider business mailing address

1213 WARWICK ST
UNIONDALE NY
11553-1416
US

V. Phone/Fax

Practice location:
  • Phone: 516-650-0899
  • Fax:
Mailing address:
  • Phone: 516-650-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number003503-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number018076-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: