Provider Demographics
NPI:1265564991
Name:QUEENSBORO OCCUPATIONAL THERAPY P.C.
Entity type:Organization
Organization Name:QUEENSBORO OCCUPATIONAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTRL CHT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:ANIBAL
Authorized Official - Last Name:MARTINS
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL CHT
Authorized Official - Phone:516-504-4263
Mailing Address - Street 1:107 NORTHERN BLVD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4311
Mailing Address - Country:US
Mailing Address - Phone:516-504-4263
Mailing Address - Fax:718-281-4263
Practice Address - Street 1:11420 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:SO OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420
Practice Address - Country:US
Practice Address - Phone:718-845-4616
Practice Address - Fax:718-845-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007678225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4017470001Medicare NSC
NY04362Medicare PIN