Healthcare Provider Details

I. General information

NPI: 1962205187
Provider Name (Legal Business Name): OPEN DOOR PT OT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2025
Last Update Date: 03/31/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10322 ROCKAWAY BEACH BLVD
ROCKAWAY PARK NY
11694-2739
US

IV. Provider business mailing address

10322 ROCKAWAY BEACH BLVD
ROCKAWAY PARK NY
11694-2739
US

V. Phone/Fax

Practice location:
  • Phone: 718-318-8550
  • Fax:
Mailing address:
  • Phone: 718-318-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ARON CHARACH
Title or Position: AUTHORIZED OFFICIAL
Credential: DPT
Phone: 646-275-6111