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General NPI Number Information
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NPI Number | 1851599617
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Entity Type | Individual
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Provider Name | STEPHEN A SANACORE P.T.A.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 06/13/2018
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Provider Practice Location Address
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Address Line | 1213 WARWICK ST
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City | UNIONDALE
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State | NY
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Zip | 11553
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Country | US
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Telephone | 516-650-0899
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 WARWICK ST
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City | UNIONDALE
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State | NY
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Zip | 11553-1416
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Country | US
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Telephone | 516-650-0899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 018076-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 003503-1
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License Number State | NY
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