Provider Demographics
NPI:1477175974
Name:CONSTELLATION HOME BASED THERAPY LLC
Entity Type:Organization
Organization Name:CONSTELLATION HOME BASED THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YITZCHOK
Authorized Official - Middle Name:
Authorized Official - Last Name:STEG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-705-4811
Mailing Address - Street 1:20 E SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1260
Mailing Address - Country:US
Mailing Address - Phone:516-705-4815
Mailing Address - Fax:516-887-8494
Practice Address - Street 1:20 E SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1260
Practice Address - Country:US
Practice Address - Phone:516-705-4815
Practice Address - Fax:516-887-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty