Healthcare Provider Details

I. General information

NPI: 1023605672
Provider Name (Legal Business Name): ANTHONY JOSEPH SANSOTTA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MONTAUK HWY STE 103
WEST ISLIP NY
11795-4429
US

IV. Provider business mailing address

400 MONTAUK HWY STE 103
WEST ISLIP NY
11795-4429
US

V. Phone/Fax

Practice location:
  • Phone: 631-661-3700
  • Fax:
Mailing address:
  • Phone: 631-661-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number046741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: