Provider Demographics
NPI:1740430974
Name:THERAPY ECT
Entity Type:Organization
Organization Name:THERAPY ECT
Other - Org Name:OTREHAB ECT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBENOV
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:917-589-8828
Mailing Address - Street 1:PO BOX 747835
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-7835
Mailing Address - Country:US
Mailing Address - Phone:917-589-8828
Mailing Address - Fax:
Practice Address - Street 1:8442 151ST ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1618
Practice Address - Country:US
Practice Address - Phone:917-589-8828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013793-1320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities