Provider Demographics
NPI:1962545426
Name:NORTH SHORE OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:NORTH SHORE OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, CHT
Authorized Official - Phone:516-625-6600
Mailing Address - Street 1:1 EXPRESSWAY PLZ
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2047
Mailing Address - Country:US
Mailing Address - Phone:516-625-6600
Mailing Address - Fax:516-625-1819
Practice Address - Street 1:1 EXPRESSWAY PLZ
Practice Address - Street 2:SUITE 106
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2047
Practice Address - Country:US
Practice Address - Phone:516-625-6600
Practice Address - Fax:516-625-1819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001270332BC3200X
NY0012270225X00000X, 332B00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001270 NO2OtherHIP
NY11478170OtherCAQH
NY0029110OtherAETNA (ORTHONET)
NY179947POtherHIP
NY6636543OtherCIGNA
NYQRW351OtherEMPIRE MEDICARE
NY29110OtherCIGNA (ORTHONET)
NY4465856OtherAETNA
NY4C0378OtherHEALTHNET
NY141769242082OtherHEALTH FIRST
NY001270SOtherHEALTHCARE PARTNERS
NYQS7142OtherEMPIRE
NYANC1449OtherOXFORD
NY=========OtherACN
NYANC1449OtherOXFORD
NY4C0378OtherHEALTHNET