Provider Demographics
NPI:1457432494
Name:JOHNSON UPPER EXTREMITY OT SERVICES, PC
Entity Type:Organization
Organization Name:JOHNSON UPPER EXTREMITY OT SERVICES, PC
Other - Org Name:JOHNSON HAND THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARYL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OT, CHT
Authorized Official - Phone:212-721-0460
Mailing Address - Street 1:PO BOX 237046
Mailing Address - Street 2:ANSONIA STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-0028
Mailing Address - Country:US
Mailing Address - Phone:212-721-0460
Mailing Address - Fax:646-559-2792
Practice Address - Street 1:160 W 66TH ST
Practice Address - Street 2:SUITE 37-J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6555
Practice Address - Country:US
Practice Address - Phone:212-721-0460
Practice Address - Fax:646-559-2792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ5962Q5061OtherMEDICARE
NYQ5962Q5061OtherMEDICARE