MEDICARE: MR. PIOTR SROKA P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	013642	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Q31391	OTHER	NY	BLUECROSS BLUESHIELD-MP
3	6604263	OTHER	NY	GHI
4	AZ00952	OTHER	NY	MDNY
5	Q31392	OTHER	NY	BLUE CROSS BLUE SHIELD
6	819836	OTHER	NY	MPN
7	013642	OTHER	NY	HIP
8	195036	OTHER	NY	UNITED HEALTHCARE
9	A2517394	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1124023478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PIOTR SROKA P.T.

Provider Business Mailing Address
First Line	:	36 IMPERIAL DR
Second Line	:
City	:	MILLER PLACE
State	:	NY
Zip	:	11764-3222
Country	:	US
Telephone Number	:	631-476-7686
Fax Number	:	631-821-3462

Provider Business Practice Location Address
First Line	:	517 OAK ST
Second Line	:
City	:	COPIAGUE
State	:	NY
Zip	:	11726-3244
Country	:	US
Telephone Number	:	631-789-3789
Fax Number	:	631-789-3728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. PIOTR SROKA P.T.” Practice Location

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