Basic Information
| Provider Information | |||||||||
| NPI: | 1659619294 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | KIRKPATRICK | ||||||||
| FirstName: | NICHOLAS | ||||||||
| MiddleName: | ANDREW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4175 VETERANS MEMORIAL HWY | ||||||||
| Address2: | |||||||||
| City: | RONKONKOMA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117797639 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6315805200 | ||||||||
| FaxNumber: | 6315805222 | ||||||||
| Practice Location | |||||||||
| Address1: | 143 SOUND BEACH AVE | ||||||||
| Address2: | |||||||||
| City: | OLD GREENWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068701736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2038170196 | ||||||||
| FaxNumber: | 2038170199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2013 | ||||||||
| LastUpdateDate: | 06/25/2014 | ||||||||
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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 | 225100000X | 10117 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 035225 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.