Provider Demographics
NPI:1538526868
Name:M.R.J OT CONTRACT SERVICE PC
Entity type:Organization
Organization Name:M.R.J OT CONTRACT SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:HAACKER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:917-517-4421
Mailing Address - Street 1:PO BOX 690798
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11369-0798
Mailing Address - Country:US
Mailing Address - Phone:917-517-4421
Mailing Address - Fax:
Practice Address - Street 1:8815 146TH ST
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3634
Practice Address - Country:US
Practice Address - Phone:917-517-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-M.R.J OT CONTRACT SERVICE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-17
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013637252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1144541467Medicaid