Basic Information
| Provider Information | |||||||||
| NPI: | 1356822589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICHALSKI | ||||||||
| FirstName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 339 | ||||||||
| Address2: | |||||||||
| City: | WADING RIVER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117920339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315042159 | ||||||||
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| Practice Location | |||||||||
| Address1: | 575 CLAYTON ST | ||||||||
| Address2: | |||||||||
| City: | CENTRAL ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117223021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312340550 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2018 | ||||||||
| LastUpdateDate: | 08/26/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 029177 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.