Healthcare Provider Details

I. General information

NPI: 1962336214
Provider Name (Legal Business Name): BRIAN JAMES CORDTS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 COURT ST STE 1217
BROOKLYN NY
11201-4410
US

IV. Provider business mailing address

12 HAYES HILL DR
NORTHPORT NY
11768-1332
US

V. Phone/Fax

Practice location:
  • Phone: 631-300-8055
  • Fax:
Mailing address:
  • Phone: 631-300-8055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: