Provider Demographics
NPI:1326483777
Name:AMY ROSENBERG SNYDER OT PC
Entity Type:Organization
Organization Name:AMY ROSENBERG SNYDER OT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:716-665-9644
Mailing Address - Street 1:4433 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-9634
Mailing Address - Country:US
Mailing Address - Phone:716-665-9644
Mailing Address - Fax:716-789-2106
Practice Address - Street 1:4433 POTTER RD
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:14757-9634
Practice Address - Country:US
Practice Address - Phone:716-665-9644
Practice Address - Fax:716-789-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005813-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02617765Medicaid