1447283882 NPI number — DIVERSIFIED SERVICES FOR OCCUPATIONAL THERAPY, PHYSICAL THER

Table of content: (NPI 1447283882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447283882 NPI number — DIVERSIFIED SERVICES FOR OCCUPATIONAL THERAPY, PHYSICAL THER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIVERSIFIED SERVICES FOR OCCUPATIONAL THERAPY, PHYSICAL THER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447283882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2900 DELAWARE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENMORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14217-2309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-871-9883
Provider Business Mailing Address Fax Number:
716-871-9887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENMORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14217-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-871-9883
Provider Business Practice Location Address Fax Number:
716-871-9887
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GRUTTADAURIA
Authorized Official First Name:
SALVATORE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT-CEO
Authorized Official Telephone Number:
716-871-9883

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  000846 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 001149 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02671290 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02700365 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02690875 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01806404 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02690884 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02667421 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com