Healthcare Provider Details

I. General information

NPI: 1639677578
Provider Name (Legal Business Name): SARA GREENBLATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 MONTAUK HWY
CENTER MORICHES NY
11934-3537
US

IV. Provider business mailing address

115 JACKIE CT
PATCHOGUE NY
11772-3395
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 Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number009608-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: