Provider Demographics
NPI:1821381922
Name:TRINITY PHYSICAL OCCUPATIONAL AND SPEECH THERAPY
Entity Type:Organization
Organization Name:TRINITY PHYSICAL OCCUPATIONAL AND SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-279-5111
Mailing Address - Street 1:1454 ROUTE 22
Mailing Address - Street 2:SUITE B101,B102
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4346
Mailing Address - Country:US
Mailing Address - Phone:845-279-5111
Mailing Address - Fax:845-279-5121
Practice Address - Street 1:1454 ROUTE 22
Practice Address - Street 2:SUITE B101,B102
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4346
Practice Address - Country:US
Practice Address - Phone:845-279-5111
Practice Address - Fax:845-279-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023515252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL998Q815R1Medicare PIN