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General NPI Number Information
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NPI Number | 1336604222
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Entity Type | Organization
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Legal Business Name | LAKE SUCCESS PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 02/05/2019
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 1999 MARCUS AVE STE M15
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1023
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Country | US
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Telephone | 516-488-8808
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Fax | 516-488-8818
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Provider Business Mailing Address
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Address Line | 1999 MARCUS AVE STE M15
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1023
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Country | US
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Telephone | 516-488-8808
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. MICHELLE DRAGAN
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Credential |
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Telephone | 516-488-8808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number |
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License Number State |
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