Healthcare Provider Details

I. General information

NPI: 1467362798
Provider Name (Legal Business Name): LOGAN EMILY PECKMAN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 BROADWAY
MASSAPEQUA NY
11758-2314
US

IV. Provider business mailing address

669 BROADWAY
MASSAPEQUA NY
11758-2314
US

V. Phone/Fax

Practice location:
  • Phone: 516-799-2900
  • Fax: 516-799-2928
Mailing address:
  • Phone: 516-799-2900
  • Fax: 516-799-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number011858
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: