Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 0138961 | NY |
N | 2251H1200X | Hand | 0138961 | NY |
N | 2251S0007X | Physical Therapist - Sports | 0138961 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 0138961 | NY |
NPI | 1457321911 |
---|---|
Provider Name | Mr. Steven C Desousa |
First Address | East Northport, NY 11731-4205 |
Second Address | East Northport, NY 11731-4205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 18/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01914598 | (05) | NY |
54388 | VYTRA ID (01) | |
6699926 | GHI PROVIDER ID (01) | |
A2517039 | OXFORD PROVIDER ID (01) | |
AZ00899 | MDNY PROVIDER ID (01) | |
Q38811 | BC BS PROVIDER ID (01) |