Provider Demographics
NPI:1689991788
Name:NY THERAAPY PLACEMENY, INC
Entity Type:Organization
Organization Name:NY THERAAPY PLACEMENY, INC
Other - Org Name:11
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:JANELLE
Authorized Official - Last Name:SHELLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:515-209-7618
Mailing Address - Street 1:162 SYMPHONY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1315
Mailing Address - Country:US
Mailing Address - Phone:516-209-7618
Mailing Address - Fax:
Practice Address - Street 1:162 SYMPHONY DR
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755
Practice Address - Country:US
Practice Address - Phone:516-209-7618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012229282N00000X, 302F00000X
NY0012229302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No282N00000XHospitalsGeneral Acute Care Hospital