Provider Demographics
NPI:1285825612
Name:ZACK, RUTH (MA OTRL)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:ZACK
Suffix:
Gender:F
Credentials:MA OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 EAST SHORE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023
Mailing Address - Country:US
Mailing Address - Phone:516-829-4525
Mailing Address - Fax:516-498-2477
Practice Address - Street 1:299 EAST SHORE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023
Practice Address - Country:US
Practice Address - Phone:516-829-4525
Practice Address - Fax:516-498-2477
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0055861225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics