Healthcare Provider Details

I. General information

NPI: 1649414723
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: 04/21/2009
Last Update Date: 04/21/2009
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

PO BOX 1312
CENTER MORICHES NY
11934-7312
US

V. Phone/Fax

Practice location:
  • Phone: 631-874-0571
  • Fax: 631-878-0527
Mailing address:
  • Phone: 631-874-0571
  • Fax: 631-878-0527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number007249-1
License Number StateNY

VIII. Authorized Official

Name: MS. KRISTA DEBLER
Title or Position: OWNER
Credential: OTR/L
Phone: 631-874-0571