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General NPI Number Information
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NPI Number | 1639124571
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Entity Type | Organization
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Legal Business Name | HEALTH 1 MEDICAL PC
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 2780 MIDDLE COUNTRY RD SUITE 140
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City | LAKE GROVE
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State | NY
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Zip | 11755-2124
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Country | US
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Telephone | 631-580-1000
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Fax | 631-580-0483
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Provider Business Mailing Address
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Address Line | 2780 MIDDLE COUNTRY RD SUITE 140
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City | LAKE GROVE
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State | NY
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Zip | 11755-2124
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Country | US
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Telephone | 631-580-1000
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Fax | 631-580-0483
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Authorized Official
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Title or Position | OWNER
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Name | GARY DICANIO
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Credential | DO
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Telephone | 631-580-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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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 | 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 #3
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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 #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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