MEDICARE: PINNACLE THERAPY SLP 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
1	235Z00000X	Speech-Language Pathologist	018865	NY
2	225X00000X	Occupational Therapist	006595-1	NY
3	225100000X	Physical Therapist	032949-1	NY

General Provider Information

NPI Number	:	1326392341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE THERAPY SLP OT PT PLLC

Provider Business Mailing Address
First Line	:	3208 AVENUE K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4141
Country	:	US
Telephone Number	:	917-306-2509
Fax Number	:

Provider Business Practice Location Address
First Line	:	3208 AVENUE K
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-4141
Country	:	US
Telephone Number	:	917-306-2509
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MICHAEL KHAVIS
Credential	:
Telephone Number	:	917-306-2509

Provider Enumeration Date	:	10/29/2012
Last Update Date	:	02/23/2016

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