| Patchogue-medford Ptdc | |
|
105 Medford Ave, Patchogue, NY 11772-1223 | |
| (631) 617-5040 | |
| (631) 617-5559 |
| Full Name | Patchogue-medford Ptdc |
|---|---|
| Type | Facility |
| Speciality | Physical Therapist |
| Location | 105 Medford Ave, Patchogue, New York |
| Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255703807 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 111N00000X | Chiropractor | 004766 (New York) | Secondary |
| 225100000X | Physical Therapist | 025310 (New York) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Patchogue-medford Ptdc 2103 Deer Park Ave, Deer Park, NY 11729-1317 Ph: (631) 242-4500 | Patchogue-medford Ptdc 105 Medford Ave, Patchogue, NY 11772-1223 Ph: (631) 617-5040 |
Ronald Amaya Lopez, DPT Physical Therapist Medicare: Medicare Enrolled Practice Location: 322 W Main St, Patchogue, NY 11772 Phone: 631-228-4977 | |
Sungguk Bae, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 21 Cleveland St, Patchogue, NY 11772 Phone: 631-569-9373 | |
Nicole Marie Divirgilio, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 77 Route 112 Ste F, Patchogue, NY 11772 Phone: 631-207-2370 | |
John Lowe Wilson, PT Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 25 Theresa Ct, Patchogue, NY 11772 Phone: 631-730-3326 | |
Danielle M Bousquet, Physical Therapist Medicare: Not Enrolled in Medicare Practice Location: 77 Medford Ave, Patchogue, NY 11772 Phone: 631-758-1910 | |
Stephanie Lauren Vanschaick, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 77 Medford Ave, Patchogue, NY 11772 Phone: 631-758-1910 Fax: 631-758-1984 | |
Kathleen Alyssa Bailey, DPT Physical Therapist Medicare: Accepting Medicare Assignments Practice Location: 322 W Main St, Patchogue, NY 11772 Phone: 631-228-4977 |