Healthcare Provider Details

I. General information

NPI: 1750416442
Provider Name (Legal Business Name): AL D. ANSON III M.S.,OTR,P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BRISTOL CT
WHEATLEY HEIGHTS NY
11798-1502
US

IV. Provider business mailing address

14 BRISTOL CT
WHEATLEY HEIGHTS NY
11798-1502
US

V. Phone/Fax

Practice location:
  • Phone: 631-254-6504
  • Fax:
Mailing address:
  • Phone: 631-254-6504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number003210-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: