Provider Demographics
NPI:1972963874
Name:WILLIAM JOSEPH VANVYNCK PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:WILLIAM JOSEPH VANVYNCK PHYSICAL THERAPY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VANVYNCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:516-637-0791
Mailing Address - Street 1:175 E MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2939
Mailing Address - Country:US
Mailing Address - Phone:631-427-7600
Mailing Address - Fax:631-427-7636
Practice Address - Street 1:175 E MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2939
Practice Address - Country:US
Practice Address - Phone:631-427-7600
Practice Address - Fax:631-427-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400058253Medicare PIN