Provider Demographics
NPI:1437401999
Name:S.R.OCCUPATIONAL & MASSAGE THERAPY,PC
Entity Type:Organization
Organization Name:S.R.OCCUPATIONAL & MASSAGE THERAPY,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RONIS
Authorized Official - Suffix:
Authorized Official - Credentials:MSOTRLMT
Authorized Official - Phone:917-403-4448
Mailing Address - Street 1:20920 33RD RD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-1421
Mailing Address - Country:US
Mailing Address - Phone:917-403-4448
Mailing Address - Fax:718-224-3129
Practice Address - Street 1:20920 33RD RD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-1421
Practice Address - Country:US
Practice Address - Phone:917-403-4448
Practice Address - Fax:718-224-3129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003946-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty