Provider Demographics
NPI:1902909401
Name:SANSONE, THOMAS J (PT)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:J
Last Name:SANSONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2600
Mailing Address - Country:US
Mailing Address - Phone:631-581-7707
Mailing Address - Fax:631-581-0049
Practice Address - Street 1:126 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2600
Practice Address - Country:US
Practice Address - Phone:631-581-7707
Practice Address - Fax:631-581-0049
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004741225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01119786Medicaid
Q53142Medicare ID - Type Unspecified