Provider Demographics
NPI:1942462338
Name:ROSEANN VANDERBECK OTR PC
Entity Type:Organization
Organization Name:ROSEANN VANDERBECK OTR PC
Other - Org Name:SOUTH SHORE THERAPY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:516-241-3684
Mailing Address - Street 1:71 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563
Mailing Address - Country:US
Mailing Address - Phone:516-241-3684
Mailing Address - Fax:516-887-6174
Practice Address - Street 1:559 ATLANTIC AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:EAST ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11518
Practice Address - Country:US
Practice Address - Phone:516-872-4605
Practice Address - Fax:516-872-4606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSEANN VANDERBECK OTR PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-27
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0029301225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty