Provider Demographics
NPI:1487674891
Name:NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY, PLLC
Entity Type:Organization
Organization Name:NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-665-8645
Mailing Address - Street 1:569 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8505
Mailing Address - Country:US
Mailing Address - Phone:631-665-8645
Mailing Address - Fax:631-665-8646
Practice Address - Street 1:763 LARKFIELD ROAD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725
Practice Address - Country:US
Practice Address - Phone:631-462-0118
Practice Address - Fax:631-462-0827
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5W161Medicare PIN
Q5W161Medicare ID - Type Unspecified
NYQ5W161Medicare UPIN