Provider Demographics
NPI:1588058275
Name:WILEY, STEPHEN A (DPT)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:A
Last Name:WILEY
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:3385 VETERANS MEMORIAL HWY STE I
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 BRYANT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1139
Practice Address - Country:US
Practice Address - Phone:516-484-9775
Practice Address - Fax:516-625-7701
Is Sole Proprietor?:No
Enumeration Date:2015-03-20
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038400-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist