Healthcare Provider Details

I. General information

NPI: 1134827363
Provider Name (Legal Business Name): COMPREHENSIVE OT, PT, SLP & ADULT HEALTH NP SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 KENSINGTON WAY
MIDDLETOWN NY
10940-2104
US

IV. Provider business mailing address

8 KENSINGTON WAY
MIDDLETOWN NY
10940-2104
US

V. Phone/Fax

Practice location:
  • Phone: 845-641-9413
  • Fax: 800-509-6099
Mailing address:
  • Phone: 845-641-9413
  • Fax: 800-509-6099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: BERGSON LOUIS-JACQUES
Title or Position: CEO
Credential:
Phone: 845-641-9413