Healthcare Provider Details

I. General information

NPI: 1225645039
Provider Name (Legal Business Name): RS1 OCCUPATIONAL THERAPY P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2020
Last Update Date: 09/25/2020
Certification Date: 09/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WASHINGTON AVE
CEDARHURST NY
11516-1913
US

IV. Provider business mailing address

22 STEVEN DR
HEWLETT NY
11557-1009
US

V. Phone/Fax

Practice location:
  • Phone: 516-302-5076
  • Fax: 516-612-7528
Mailing address:
  • Phone: 516-302-5076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RUCHIR SHAH
Title or Position: PRESIDENT
Credential: MS, OTR/L
Phone: 516-302-5076