Healthcare Provider Details

I. General information

NPI: 1023401841
Provider Name (Legal Business Name): ACHIEVE PT OT SLP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2015
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

776 UNIVERSITY ST
VALLEY STREAM NY
11581-3518
US

IV. Provider business mailing address

776 UNIVERSITY ST
VALLEY STREAM NY
11581-3518
US

V. Phone/Fax

Practice location:
  • Phone: 516-220-0649
  • Fax: 516-569-1901
Mailing address:
  • Phone: 516-220-0649
  • Fax: 516-569-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031038
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002989
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number022340
License Number StateNY

VIII. Authorized Official

Name: YITZCHOK KOLODNY
Title or Position: OWNER
Credential: DPT
Phone: 516-220-0649