Provider Demographics
NPI:1063454577
Name:SPEAR PHYSICAL AND OCCUPATIONAL THERAPY, LLC
Entity Type:Organization
Organization Name:SPEAR PHYSICAL AND OCCUPATIONAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOTENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:212-759-2211
Mailing Address - Street 1:307 5TH AVENUE
Mailing Address - Street 2:6TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-759-2282
Mailing Address - Fax:212-379-2123
Practice Address - Street 1:120 E 56TH ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3607
Practice Address - Country:US
Practice Address - Phone:212-759-2211
Practice Address - Fax:212-829-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017761-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP1540441OtherOXFORD
NY32101OtherCIGNA
NYBCBS - Q5W3A1OtherBCBS
NYBCBS - Q5W3A1OtherBCBS