Provider Demographics
NPI:1912198342
Name:GREAT NECK OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:GREAT NECK OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZACK
Authorized Official - Suffix:
Authorized Official - Credentials:MA OTRL
Authorized Official - Phone:516-829-4525
Mailing Address - Street 1:299 EAST SHORE ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023
Mailing Address - Country:US
Mailing Address - Phone:516-829-4525
Mailing Address - Fax:516-498-2477
Practice Address - Street 1:299 EAST SHORE ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023
Practice Address - Country:US
Practice Address - Phone:516-829-4525
Practice Address - Fax:516-498-2477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREAT NECK OCCUPATIONAL THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0055861225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty