Healthcare Provider Details

I. General information

NPI: 1902189285
Provider Name (Legal Business Name): GRAND HEALTH CARE PT OT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4344 KISSENA BLVD SUITE LA
FLUSHING NY
11355-3784
US

IV. Provider business mailing address

PO BOX 528160
FLUSHING NY
11352-8160
US

V. Phone/Fax

Practice location:
  • Phone: 718-878-2224
  • Fax: 718-878-2010
Mailing address:
  • Phone: 718-878-2224
  • Fax: 718-878-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number029200
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number010855
License Number StateNY

VIII. Authorized Official

Name: JAY SARKAR
Title or Position: PRESIDENT
Credential: OT
Phone: 718-878-2224