Provider Demographics
NPI:1710507520
Name:STRAUT, DAVID W
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:STRAUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 SOMERSET DR
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-6901
Mailing Address - Country:US
Mailing Address - Phone:201-245-5391
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORT CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10573-4402
Practice Address - Country:US
Practice Address - Phone:201-245-5391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-22
Last Update Date:2021-05-18
Deactivation Date:2020-04-23
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
NY009835224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant