Healthcare Provider Details

I. General information

NPI: 1356010524
Provider Name (Legal Business Name): MICHAEL ROFF OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 IRWIN PL
HUNTINGTON NY
11743-3608
US

IV. Provider business mailing address

45 IRWIN PL
HUNTINGTON NY
11743-3608
US

V. Phone/Fax

Practice location:
  • Phone: 631-626-3142
  • Fax:
Mailing address:
  • Phone: 631-626-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number025919
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: