Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | PT022196 | NY |
NPI | 1063549400 |
---|---|
Provider Name | Diane Scalogna |
First Address | Port Jefferson Station, NY 11776 |
Second Address | E Setauket, NY 11733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 08/07/2007 |