Healthcare Provider Details

I. General information

NPI: 1700340973
Provider Name (Legal Business Name): SENSORY SOLUTIONS OF LONG ISLAND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5225 NESCONSET HWY BUIDLING# 3, SUITE 11&12
PORT JEFFERSON STATION NY
11776-2054
US

IV. Provider business mailing address

3 JOES WAY
CENTEREACH NY
11720-1932
US

V. Phone/Fax

Practice location:
  • Phone: 631-525-7514
  • Fax:
Mailing address:
  • Phone: 631-525-7514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. REGINA PROVISIERO
Title or Position: OWNER
Credential: MA-CCC-SLP
Phone: 631-525-7514