Healthcare Provider Details

I. General information

NPI: 1831526722
Provider Name (Legal Business Name): SOAR INTO ACTION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 04/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 NASSAU BLVD
GARDEN CITY NY
11530-5314
US

IV. Provider business mailing address

306 NASSAU BLVD
GARDEN CITY NY
11530-5314
US

V. Phone/Fax

Practice location:
  • Phone: 516-208-2100
  • Fax:
Mailing address:
  • Phone: 516-208-2100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AMY EAPEN
Title or Position: OWNER
Credential: DPT
Phone: 516-208-2100