Provider Demographics
NPI:1831119247
Name:NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Entity Type:Organization
Organization Name:NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANGER
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELFERCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-665-8645
Mailing Address - Street 1:569 E MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8505
Mailing Address - Country:US
Mailing Address - Phone:631-665-8645
Mailing Address - Fax:631-665-8646
Practice Address - Street 1:16558 BAISLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROCHDALE
Practice Address - State:NY
Practice Address - Zip Code:11434
Practice Address - Country:US
Practice Address - Phone:718-341-4431
Practice Address - Fax:718-341-6146
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW YORK PHYSICAL AND OCCUPATIONAL THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-20
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ3W3H1Medicare PIN