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General NPI Number Information
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NPI Number | 1770913196
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Entity Type | Organization
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Legal Business Name | NORTH SHORE PHYSICAL THERAPY AND OCCUPATIONAL THERAPY, PLLC
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Dates
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Enumeration Date | 11/21/2013
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 290 COMMUNITY DR
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City | GREAT NECK
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State | NY
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Zip | 11021-5504
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Country | US
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Telephone | 516-304-5530
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Fax |
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Provider Business Mailing Address
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Address Line | 36 WASHINGTON AVE
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City | GLEN HEAD
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State | NY
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Zip | 11545-1543
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Country | US
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Telephone | 516-304-5530
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. MICHAEL PFEIFFER
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Credential | OTR
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Telephone | 516-304-5530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 022139
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0107531
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 0342841
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License Number State | NY
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