Provider Demographics
NPI:1902189285
Name:GRAND HEALTH CARE PT OT PLLC
Entity Type:Organization
Organization Name:GRAND HEALTH CARE PT OT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKAR
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:718-878-2224
Mailing Address - Street 1:PO BOX 528160
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-8160
Mailing Address - Country:US
Mailing Address - Phone:718-878-2224
Mailing Address - Fax:718-878-2010
Practice Address - Street 1:4344 KISSENA BLVD
Practice Address - Street 2:SUITE LA
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3784
Practice Address - Country:US
Practice Address - Phone:718-878-2224
Practice Address - Fax:718-878-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029200225100000X
NY010855225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty