Provider Demographics
NPI:1649414723
Name:OUT EAST THERAPY OF NEW YORK FOR OT, PT, SLP, RN AND PSYCHOLOGY SERVIC
Entity Type:Organization
Organization Name:OUT EAST THERAPY OF NEW YORK FOR OT, PT, SLP, RN AND PSYCHOLOGY SERVIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBLER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:631-874-0571
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934-7312
Mailing Address - Country:US
Mailing Address - Phone:631-874-0571
Mailing Address - Fax:631-878-0527
Practice Address - Street 1:77 UNION AVE
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3213
Practice Address - Country:US
Practice Address - Phone:631-874-0571
Practice Address - Fax:631-878-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007249-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency