Provider Demographics
NPI:1336548213
Name:WATSON, PHILIP EDWIN (MS, ATC)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:EDWIN
Last Name:WATSON
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 HEMPSTEAD TPKE
Mailing Address - Street 2:NEW YORK ISLANDERS
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-1260
Mailing Address - Country:US
Mailing Address - Phone:516-501-6700
Mailing Address - Fax:516-501-6835
Practice Address - Street 1:1255 HEMPSTEAD TPKE
Practice Address - Street 2:NEW YORK ISLANDERS
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-1260
Practice Address - Country:US
Practice Address - Phone:516-501-6700
Practice Address - Fax:516-501-6835
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002439-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer