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General NPI Number Information
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NPI Number | 1972224632
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Entity Type | Organization
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Legal Business Name | UP AND ON PHYSICALWELLNESS OF LONG ISLAND LLC
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/09/2022
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Provider Practice Location Address
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Address Line | 149 OLD COUNTRY RD
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City | DEER PARK
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State | NY
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Zip | 11729-1920
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Country | US
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Telephone | 607-220-9068
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Fax |
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Provider Business Mailing Address
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Address Line | 149 OLD COUNTRY RD
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City | DEER PARK
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State | NY
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Zip | 11729-1920
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Country | US
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Telephone | 607-220-9068
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER/OWNER
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Name | SANGEETHA RAJYAM
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Credential |
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Telephone | 607-220-9068
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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 |
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License Number State |
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