Mark Joseph Gugliotti, PT,DPT,MS,BSC,OCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

015702 Issued in NY

Practice address

200 Belle Terre Rd
Port Jefferson, NY 11777-1928

Phone

(631) 474-6111

NPI assigned

Apr 2, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679694517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2397 N WADING RIVER RD",
            "city": "WADING RIVER",
            "state": "NY",
            "postal_code": "117921411",
            "telephone_number": "631-929-7276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 BELLE TERRE RD",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771928",
            "telephone_number": "631-474-6111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUGLIOTTI",
        "first_name": "MARK",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "PT,DPT,MS,BSC,OCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "015702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theresa Grimes, FNP-BC
• Shelly Stephens Groenendyk, MD
• Maritza Lastra Groth, MD
• Jenna Guardino, RN BSN FNP B.C
• Mary Elizabeth Guerrero, M.S, CCC-SLP
• Swati Gupta
• George Ioanis Habeos I, MD
• Melissa Hafner, P.T.
• Hibah Haider
• Perla Halegoua, M.A.,C.C.C.

• Physical Therapist in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.