Provider Demographics
NPI:1912225038
Name:COBY SCACCIA PT, PC
Entity type:Organization
Organization Name:COBY SCACCIA PT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:COBY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SCACCIA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-858-2858
Mailing Address - Street 1:58 OCEANVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MASTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11951-1522
Mailing Address - Country:US
Mailing Address - Phone:518-858-2858
Mailing Address - Fax:631-657-3858
Practice Address - Street 1:58 OCEANVIEW DR
Practice Address - Street 2:
Practice Address - City:MASTIC BEACH
Practice Address - State:NY
Practice Address - Zip Code:11951-1522
Practice Address - Country:US
Practice Address - Phone:518-858-2858
Practice Address - Fax:631-657-3858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013823-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty