Provider Demographics
NPI:1942699749
Name:C.J. ALLEN OT UPPER EXTREMITY & HAND THERAPY, PLLC
Entity Type:Organization
Organization Name:C.J. ALLEN OT UPPER EXTREMITY & HAND THERAPY, PLLC
Other - Org Name:C.J. ALLEN OT CHT UPPER EXTREMITY & HAND THERAPY, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CHT
Authorized Official - Phone:516-779-6798
Mailing Address - Street 1:20 AMBER CT
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-3107
Mailing Address - Country:US
Mailing Address - Phone:631-761-6996
Mailing Address - Fax:631-761-6997
Practice Address - Street 1:2108 JOSHUAS PATH
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4764
Practice Address - Country:US
Practice Address - Phone:631-761-6996
Practice Address - Fax:631-761-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-16
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011083225XH1200X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty