MEDICARE: ADVANTAGE PHYSICAL & OCCUPATIONAL THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist
2	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	N81820	OTHER	NY	HEALTH NET ID
2	1125744	OTHER		EMBLEM
3	P2967582	OTHER	NY	OXFORD HEALTH PLANS ID

General Provider Information

NPI Number	:	1023164282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANTAGE PHYSICAL & OCCUPATIONAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	534 W 112TH ST # 872
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-9721
Country	:	US
Telephone Number	:	917-716-5392
Fax Number	:	212-820-9773

Provider Business Practice Location Address
First Line	:	534 W 112TH ST # 872
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-9721
Country	:	US
Telephone Number	:	917-716-5392
Fax Number	:	212-820-9773

Authorized Official
Title or Position	:	OWNER
Name	:	ROBIN HOPE STOLLER
Credential	:	PT
Telephone Number	:	646-960-2006

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	04/29/2022

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