Provider Demographics
NPI:1730467572
Name:HOME ADVANTAGE OCCUPATIONAL THERAPY, P.C.
Entity Type:Organization
Organization Name:HOME ADVANTAGE OCCUPATIONAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MARZANO
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:516-729-4834
Mailing Address - Street 1:2721 LEE PL
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-5003
Mailing Address - Country:US
Mailing Address - Phone:516-729-4834
Mailing Address - Fax:516-706-2182
Practice Address - Street 1:2721 LEE PL
Practice Address - Street 2:
Practice Address - City:BELLMORE
Practice Address - State:NY
Practice Address - Zip Code:11710-5003
Practice Address - Country:US
Practice Address - Phone:516-729-4834
Practice Address - Fax:516-706-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010005174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02584632Medicaid
NYA300000511OtherMEDICARE PTAN