Healthcare Provider Details

I. General information

NPI: 1427370501
Provider Name (Legal Business Name): OUT EAST THERAPY OF NEW YORK FOR OT, PT, SLP, RN AND PSYCHOLOGY SERVIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 UNION AVE
CENTER MORICHES NY
11934-3213
US

IV. Provider business mailing address

77 UNION AVE
CENTER MORICHES NY
11934-3213
US

V. Phone/Fax

Practice location:
  • Phone: 631-874-0571
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number007249
License Number StateNY

VIII. Authorized Official

Name: KRISTA DEBLER
Title or Position: OWNER
Credential:
Phone: 631-874-0571