Organization
FAM PHYSICAL THERAPY OF MILLER PLACE PC
Active
Other names
Advanced S.P.O.R.T.S. Physical Therapy Of Miller Place
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TANYA STEPHANIE DUMORNAY (MANAGER)
(718) 820-9300
Entity
Organization
Contact information
Practice address
275 ROUTE 25A, MILLER PLACE, NY 11764-2427
(631) 364-8114
(631) 364-8117
Mailing address
100 N BELLE MEAD RD, EAST SETAUKET, NY 11733-3530
(631) 689-5940
(631) 689-5943
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
014530-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218211P
HIP
NY
01
—
51376
VYTRA
NY
01
—
610109100
ACS FEDERAL WORKERS COMPENSATION
NY
01
—
6697912
GHI
NY
01
—
813473
EMPIRE PLAN (UHC)
NY
01
—
P3151561
OXFORD
NY
01
—
Q04B71
BCBS
NY
Enumeration date
09/07/2017
Last updated
09/07/2017
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