Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 039624 | NY |
NPI | 1003273376 |
---|---|
Provider Name | Steven Acquavita |
First Address | North Babylon, NY 11703-3513 |
Second Address | North Babylon, NY 11703-3513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2016 |
Last Update Date | 18/01/2016 |