Provider Demographics
NPI:1326211053
Name:SOUTH SHORE REHABILITATION OT PC
Entity Type:Organization
Organization Name:SOUTH SHORE REHABILITATION OT PC
Other - Org Name:JOAN E MURRAY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR CHT
Authorized Official - Phone:516-295-5002
Mailing Address - Street 1:123 GROVE AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2322
Mailing Address - Country:US
Mailing Address - Phone:516-295-5002
Mailing Address - Fax:516-295-2720
Practice Address - Street 1:123 GROVE AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2322
Practice Address - Country:US
Practice Address - Phone:516-295-5002
Practice Address - Fax:516-295-2720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3053-1261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ68871Medicare PIN