Provider Demographics
NPI:1699036772
Name:METRO THERAPY
Entity Type:Organization
Organization Name:METRO THERAPY
Other - Org Name:UP WEE GROW
Other - Org Type:Other Name
Authorized Official - Title/Position:MS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LARISSA
Authorized Official - Middle Name:AUDREY
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-447-1649
Mailing Address - Street 1:8 LUCY CT
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1425
Mailing Address - Country:US
Mailing Address - Phone:631-447-1649
Mailing Address - Fax:631-447-1649
Practice Address - Street 1:8 LUCY CT
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1425
Practice Address - Country:US
Practice Address - Phone:631-447-1649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPASSWORD1Medicare PIN