Provider Demographics
NPI:1649531567
Name:EAST END OCCUPATIONAL THERAPY, PLLC
Entity type:Organization
Organization Name:EAST END OCCUPATIONAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST- OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARULLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR-L
Authorized Official - Phone:631-676-4185
Mailing Address - Street 1:868 CHURCH ST STE 4
Mailing Address - Street 2:
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716-5021
Mailing Address - Country:US
Mailing Address - Phone:631-676-4185
Mailing Address - Fax:631-676-4186
Practice Address - Street 1:868 CHURCH ST STE 4
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-5021
Practice Address - Country:US
Practice Address - Phone:631-676-4185
Practice Address - Fax:631-676-4186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-07
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017178-1261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty