Healthcare Provider Details

I. General information

NPI: 1396171997
Provider Name (Legal Business Name): NEW YORK CITY OCCUPATIONAL THERAPY SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HYANIS CT
MOUNT SINAI NY
11766
US

IV. Provider business mailing address

PO BOX 285
MOUNT SINAI NY
11766-0285
US

V. Phone/Fax

Practice location:
  • Phone: 631-831-9794
  • Fax:
Mailing address:
  • Phone: 631-831-9794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number017012-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number017012-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number017012-1
License Number StateNY

VIII. Authorized Official

Name: DANIELLE PELLEGRINO
Title or Position: OCCUPATIONAL THERAPIST
Credential: M.S., OTR/L
Phone: 631-831-9794