Healthcare Provider Details

I. General information

NPI: 1336169747
Provider Name (Legal Business Name): NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 WEST 100TH STREET
NEW YORK NY
10025
US

IV. Provider business mailing address

569 E MAIN STREET
BAY SHORE NY
11706-8505
US

V. Phone/Fax

Practice location:
  • Phone: 212-668-4435
  • Fax: 888-583-1268
Mailing address:
  • Phone: 631-665-8645
  • Fax: 631-665-8646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY SMALL
Title or Position: CFO
Credential:
Phone: 631-665-8645