Individual
DEREK FEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
47 CHERRY ST, LAKE RONKONKOMA, NY 11779-4325
(631) 294-8663
Mailing address
47 CHERRY ST, LAKE RONKONKOMA, NY 11779-4325
(631) 294-8663
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
010454
NY
Other
Enumeration date
04/07/2019
Last updated
04/07/2019
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