Provider Demographics
NPI:1649776683
Name:THERAPLAY DEVELOPMENTAL RESOURCES, LLC
Entity Type:Organization
Organization Name:THERAPLAY DEVELOPMENTAL RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MUNI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:646-279-1145
Mailing Address - Street 1:305 SPOOK ROCK RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4316
Mailing Address - Country:US
Mailing Address - Phone:646-526-4245
Mailing Address - Fax:
Practice Address - Street 1:305 SPOOK ROCK RD
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4316
Practice Address - Country:US
Practice Address - Phone:646-526-4245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Single Specialty