Healthcare Provider Details

I. General information

NPI: 1669513404
Provider Name (Legal Business Name): MID ISLAND THERAPY ASSOCIATES, LLC D/B/A ALL ABOUT KIDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 EXECUTIVE DR SUITE 101, LL105 & LL108
PLAINVIEW NY
11803-1718
US

IV. Provider business mailing address

255 EXECUTIVE DR SUITE 101
PLAINVIEW NY
11803-1718
US

V. Phone/Fax

Practice location:
  • Phone: 516-576-2040
  • Fax: 516-576-1615
Mailing address:
  • Phone: 516-576-2040
  • Fax: 516-576-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
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: MR. MICHAEL L. GROSSFELD
Title or Position: PARTNER-DIV. DIR.-FISCAL-NEW BUSINE
Credential: M.A., SLP
Phone: 516-576-2040