Healthcare Provider Details

I. General information

NPI: 1639823743
Provider Name (Legal Business Name): IVYREHAB PHYSICAL THERAPY, OCCUPATIONAL THERAPY & SPEECH LANGUAGE PATHOLOGY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 OLD COUNTRY RD
PLAINVIEW NY
11803-4938
US

IV. Provider business mailing address

PO BOX 416501
BOSTON MA
02241-6501
US

V. Phone/Fax

Practice location:
  • Phone: 516-681-8822
  • Fax:
Mailing address:
  • Phone: 914-265-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ASHLEY GRIFFITHS
Title or Position: SR. DIRECTOR OF PROVIDER RELATIONS
Credential:
Phone: 914-294-4050