Provider Demographics
NPI:1841526399
Name:OUTREACH PHYSICAL & OCCUPATIONAL THERAPY & SPEECH REHABILITATION, PLLC
Entity type:Organization
Organization Name:OUTREACH PHYSICAL & OCCUPATIONAL THERAPY & SPEECH REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:212-842-0080
Mailing Address - Street 1:1110 2ND AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2021
Mailing Address - Country:US
Mailing Address - Phone:212-842-0080
Mailing Address - Fax:917-591-8494
Practice Address - Street 1:1110 2ND AVENUE SUITE 302
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2021
Practice Address - Country:US
Practice Address - Phone:917-685-9334
Practice Address - Fax:917-591-8494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225XP0019X
235Z00000X
NY0248891225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty