Healthcare Provider Details

I. General information

NPI: 1841526399
Provider Name (Legal Business Name): OUTREACH PHYSICAL AND OCCUPATIONAL THERAPY & SPEECH REHABILITATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2009
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 GRACE AVENUE SUITE 119
GREAT NECK NY
11021
US

IV. Provider business mailing address

3 GRACE AVENUE SUITE 119
GREAT NECK NY
11021
US

V. Phone/Fax

Practice location:
  • Phone: 212-842-0080
  • Fax: 917-591-8494
Mailing address:
  • Phone: 212-842-0080
  • Fax: 917-591-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0248891
License Number StateNY

VIII. Authorized Official

Name: ALEX GREENSPAN
Title or Position: OPERATIONS
Credential: MSPT
Phone: 212-842-0080