Provider Demographics
NPI:1992093165
Name:LONG ISLAND PHYSICAL THERAPY SERVICES, P.C.
Entity type:Organization
Organization Name:LONG ISLAND PHYSICAL THERAPY SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:GLUCKSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:631-848-8515
Mailing Address - Street 1:1 MARCY COURT
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1942
Mailing Address - Country:US
Mailing Address - Phone:631-689-1678
Mailing Address - Fax:631-689-1678
Practice Address - Street 1:1 MARCY COURT
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1942
Practice Address - Country:US
Practice Address - Phone:631-689-1678
Practice Address - Fax:631-689-1678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty