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General NPI Number Information
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NPI Number | 1033739602
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Entity Type | Organization
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Legal Business Name | WANTAGH PHYSICAL THERAPY, CHIROPRACTIC & NURSE PRACTITIONER IN FAMILY
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 11/17/2021
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Provider Practice Location Address
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Address Line | 3305 JERUSALEM AVE STE 110
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City | WANTAGH
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State | NY
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Zip | 11793-2028
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Country | US
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Telephone | 516-320-3999
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 JERUSALEM AVE STE 110
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City | WANTAGH
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State | NY
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Zip | 11793-2028
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Country | US
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Telephone | 516-320-3999
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | STEPHEN LEMBO
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Credential |
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Telephone | 516-320-3999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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