Provider Demographics
NPI:1396120788
Name:RONKONKOMA PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:RONKONKOMA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:YARROBINO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-320-1100
Mailing Address - Street 1:958 PORTION RD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-1975
Mailing Address - Country:US
Mailing Address - Phone:631-320-1100
Mailing Address - Fax:631-320-1099
Practice Address - Street 1:1041 W JERICHO TPKE
Practice Address - Street 2:SUITE G
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3225
Practice Address - Country:US
Practice Address - Phone:631-320-1100
Practice Address - Fax:631-320-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100062453Medicare PIN