Provider Demographics
NPI:1134827363
Name:COMPREHENSIVE OT, PT, SLP & ADULT HEALTH NP SERVICES, PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE OT, PT, SLP & ADULT HEALTH NP SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERGSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIS-JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-641-9413
Mailing Address - Street 1:8 KENSINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2104
Mailing Address - Country:US
Mailing Address - Phone:845-641-9413
Mailing Address - Fax:800-509-6099
Practice Address - Street 1:8 KENSINGTON WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2104
Practice Address - Country:US
Practice Address - Phone:845-641-9413
Practice Address - Fax:800-509-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07282433Medicaid