Provider Demographics
NPI:1962418426
Name:MEYERS, JOEL L (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:L
Last Name:MEYERS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E MAIN ST
Mailing Address - Street 2:STE 202
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2844
Mailing Address - Country:US
Mailing Address - Phone:631-360-0313
Mailing Address - Fax:631-360-0317
Practice Address - Street 1:309 E MAIN ST
Practice Address - Street 2:STE 202
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2844
Practice Address - Country:US
Practice Address - Phone:631-360-0313
Practice Address - Fax:631-360-0317
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008570-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01914570Medicaid
NYQ06161Medicare ID - Type UnspecifiedPROVIDER NUMBER