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General NPI Number Information
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NPI Number | 1538286885
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Entity Type | Organization
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Legal Business Name | NASSAU SPORTS CARE WELLNESS & FITNESS PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 1204 JERICHO TPKE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-4607
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Country | US
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Telephone | 516-326-7899
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Fax | 516-326-7895
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Provider Business Mailing Address
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Address Line | 1204 JERICHO TPKE
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-4607
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Country | US
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Telephone | 516-326-7899
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Fax | 516-326-7895
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN W. KRUPA III
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Credential |
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Telephone | 516-326-7899
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 008984
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License Number State | NY
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