Healthcare Provider Details

I. General information

NPI: 1881394534
Provider Name (Legal Business Name): STEPHANIE KALOGERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 MONTAUK HWY
OAKDALE NY
11769-1492
US

IV. Provider business mailing address

27 OAKWOOD RD
BOHEMIA NY
11716-3426
US

V. Phone/Fax

Practice location:
  • Phone: 631-218-1545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number013394-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: