Provider Demographics
NPI:1801805312
Name:AMG OCCUPATIONAL THERAPY PC
Entity type:Organization
Organization Name:AMG OCCUPATIONAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:GELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTRL
Authorized Official - Phone:917-453-3200
Mailing Address - Street 1:55 NORTHERN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-4058
Mailing Address - Country:US
Mailing Address - Phone:516-466-9300
Mailing Address - Fax:516-466-9353
Practice Address - Street 1:55 NORTHERN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4058
Practice Address - Country:US
Practice Address - Phone:516-466-9300
Practice Address - Fax:516-466-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011913225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1154240OtherAETNA HMO
NY1601049OtherGHI
NY1601049OtherGHI
NY5668850001Medicare NSC
QT8071Medicare UPIN