Healthcare Provider Details

I. General information

NPI: 1063670123
Provider Name (Legal Business Name): OCCUPATIONAL THERAPY ASSOCIATES OF NEW YORK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 WATERS PLACE STE. 501
BRONX NY
10461-2720
US

IV. Provider business mailing address

1250 WATERS PLACE STE. 501
BRONX NY
10461-2720
US

V. Phone/Fax

Practice location:
  • Phone: 718-319-1740
  • Fax: 718-319-1741
Mailing address:
  • Phone: 718-319-1740
  • Fax: 718-319-1741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROSE ANNE SANGREGORIO
Title or Position: COOWNER
Credential: OTR/L
Phone: 718-319-1740