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General NPI Number Information
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NPI Number | 1851819023
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Entity Type | Organization
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Legal Business Name | FAM PHYSICAL THERAPY OF MILLER PLACE PC
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Dates
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Enumeration Date | 09/07/2017
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Last Update Date | 09/07/2017
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Provider Practice Location Address
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Address Line | 275 ROUTE 25A
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City | MILLER PLACE
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State | NY
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Zip | 11764-2427
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Country | US
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Telephone | 631-364-8114
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Fax | 631-364-8117
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Provider Business Mailing Address
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Address Line | 100 N BELLE MEAD RD
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City | EAST SETAUKET
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State | NY
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Zip | 11733-3530
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Country | US
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Telephone | 631-689-5940
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Fax | 631-689-5943
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Authorized Official
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Title or Position | MANAGER
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Name | MS. TANYA STEPHANIE DUMORNAY
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Credential |
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Telephone | 718-820-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 014530-1
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License Number State | NY
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