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NPI Code Detail

MEDICARE: YAD OT PT PLLC

MEDICARE: YAD OT PT 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
1174400000XSpecialist029579NY

General Provider Information

NPI Number : 1174927677
Entity Type Code : Organization
Provider Name (Legal Business Name) : YAD OT PT PLLC
Provider Business Mailing Address
First Line : 1565 E 36TH ST
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-3415
Country : US
Telephone Number : 917-658-7726
Fax Number :
Provider Business Practice Location Address
First Line : 1716 CONEY ISLAND AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11230-5801
Country : US
Telephone Number : 718-336-4900
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : DAVID J ETTINGER
Credential : PT
Telephone Number : 718-336-4900
Provider Enumeration Date : 10/14/2014
Last Update Date : 01/23/2015

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