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General NPI Number Information
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NPI Number | 1780118240
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Entity Type | Organization
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Legal Business Name | GREATER LONG ISLAND PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 16 PASHEN PL
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City | DIX HILLS
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State | NY
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Zip | 11746-6600
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Country | US
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Telephone | 516-672-3449
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Fax |
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Provider Business Mailing Address
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Address Line | 16 PASHEN PL
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City | DIX HILLS
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State | NY
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Zip | 11746-6600
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID WENGER
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Credential | DPT
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Telephone | 516-672-3449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 025563
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License Number State | NY
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