Provider Demographics
NPI:1174682355
Name:SCALISE, RICHARD JAMES (OTR, CHT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JAMES
Last Name:SCALISE
Suffix:
Gender:M
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 N VILLAGE AVE
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3800
Mailing Address - Country:US
Mailing Address - Phone:516-255-4263
Mailing Address - Fax:516-255-4050
Practice Address - Street 1:176 N VILLAGE AVE
Practice Address - Street 2:SUITE 2C
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-3800
Practice Address - Country:US
Practice Address - Phone:516-255-4263
Practice Address - Fax:516-255-4050
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003241225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ65762Medicare PIN
NYQ4WFH1Medicare PIN
NYA100146108Medicare PIN