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General NPI Number Information
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NPI Number | 1528440484
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Entity Type | Organization
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Legal Business Name | ELLIOT ENGELHARDT O.T., P.C.
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Dates
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Enumeration Date | 06/26/2015
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Last Update Date | 06/26/2015
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Provider Practice Location Address
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Address Line | 8229 SURREY PL
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City | JAMAICA
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State | NY
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Zip | 11432-1436
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Country | US
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Telephone | 917-750-9101
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Fax |
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Provider Business Mailing Address
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Address Line | 8229 SURREY PL
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City | JAMAICA
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State | NY
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Zip | 11432-1436
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Country | US
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Telephone | 917-750-9101
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ELLIOT S. ENGELHARDT
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Credential | MS, OTR/L, CME I
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Telephone | 917-750-9101
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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 | 015085
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License Number State | NY
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