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General NPI Number Information
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NPI Number | 1588804587
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Entity Type | Organization
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Legal Business Name | AMERICAN THERAPY GROUP
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 1840 UNION BLVD
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City | BAY SHORE
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State | NY
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Zip | 11706-7932
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Country | US
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Telephone | 631-647-7893
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Fax |
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Provider Business Mailing Address
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Address Line | 1840 UNION BLVD
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City | BAY SHORE
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State | NY
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Zip | 11706-7932
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Country | US
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Telephone | 631-647-7893
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Fax |
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Authorized Official
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Title or Position | MBR
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Name | SHAFER ZYSMAN
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Credential |
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Telephone | 631-647-7885
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 025669
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 010404-1
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License Number State | NY
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