Healthcare Provider Details

I. General information

NPI: 1457695561
Provider Name (Legal Business Name): REHAB HAVEN OCCUPATIONAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7716 164TH ST
FRESH MEADOWS NY
11366-1227
US

IV. Provider business mailing address

237A BROOKLYN AVE
BROOKLYN NY
11213-2986
US

V. Phone/Fax

Practice location:
  • Phone: 917-299-2635
  • Fax:
Mailing address:
  • Phone: 917-299-2635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number012623
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: FELER J. DUREUS
Title or Position: PRESIDENT
Credential:
Phone: 917-299-2635