Healthcare Provider Details

I. General information

NPI: 1649776683
Provider Name (Legal Business Name): THERAPLAY DEVELOPMENTAL RESOURCES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 03/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SPOOK ROCK RD
SUFFERN NY
10901-4316
US

IV. Provider business mailing address

305 SPOOK ROCK RD
SUFFERN NY
10901-4316
US

V. Phone/Fax

Practice location:
  • Phone: 646-526-4245
  • Fax:
Mailing address:
  • Phone: 646-526-4245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities 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: MR. BRIAN WILLIAM MUNI
Title or Position: EXECUTIVE DIRECTOR
Credential: OTR
Phone: 646-279-1145