Provider Demographics
NPI:1104877422
Name:CYRIAC, SAMKUTTY (PT)
Entity type:Individual
Prefix:MR
First Name:SAMKUTTY
Middle Name:
Last Name:CYRIAC
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2939
Mailing Address - Country:US
Mailing Address - Phone:917-560-1734
Mailing Address - Fax:516-352-0350
Practice Address - Street 1:1100 STEWART AVE STE B
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4839
Practice Address - Country:US
Practice Address - Phone:516-427-5380
Practice Address - Fax:516-386-6666
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0270842251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ28M21Medicare ID - Type Unspecified