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General NPI Number Information
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NPI Number | 1487944054
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Entity Type | Organization
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Legal Business Name | ROSEANN VANDERBECK OTRPC
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Dates
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Enumeration Date | 04/15/2011
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Last Update Date | 04/15/2011
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Provider Practice Location Address
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Address Line | 559 ATLANTIC AVE 202
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City | EAST ROCKAWAY
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State | NY
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Zip | 11518-1530
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Country | US
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Telephone | 516-872-4605
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Fax | 516-872-4606
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Provider Business Mailing Address
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Address Line | 71 CLINTON AVE
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City | LYNBROOK
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State | NY
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Zip | 11563-4137
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Country | US
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Telephone | 516-241-3684
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Fax | 516-872-4605
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | ROSEANN VANDERBECK
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Credential | OTR
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Telephone | 516-241-3684
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 002930-1
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License Number State | NY
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