Provider Demographics
NPI:1992822282
Name:RAHN, GREGORY JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:JOHN
Last Name:RAHN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-1836
Mailing Address - Country:US
Mailing Address - Phone:631-261-6677
Mailing Address - Fax:631-261-5533
Practice Address - Street 1:277 INDIAN HEAD RD
Practice Address - Street 2:UNIT A
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-4803
Practice Address - Country:US
Practice Address - Phone:631-269-5170
Practice Address - Fax:631-269-5283
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY5555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ59911Medicare UPIN