Provider Demographics
NPI:1093235707
Name:OPTIMIZED INDEPENDENCE OT PLLC
Entity Type:Organization
Organization Name:OPTIMIZED INDEPENDENCE OT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:SUEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:917-749-6635
Mailing Address - Street 1:78 REED DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3216
Mailing Address - Country:US
Mailing Address - Phone:917-749-6635
Mailing Address - Fax:
Practice Address - Street 1:78 REED DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3216
Practice Address - Country:US
Practice Address - Phone:917-749-6635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017794225X00000X
NY019271225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861898538OtherNPPES
1326380403OtherNPPES