Basic Information
| Provider Information | |||||||||
| NPI: | 1558582775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLATT | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MPT,ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1377 MOTOR PKWY | ||||||||
| Address2: | STE 307 | ||||||||
| City: | ISLANDIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117495258 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093241200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23659 COLUMBUS RD STE 3 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080221979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093241200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2007 | ||||||||
| LastUpdateDate: | 09/18/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 40QA00982900 | NJ | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 900148721 | 01 | NJ | TAX ID | OTHER |