Provider Demographics
NPI:1538618426
Name:SUYDAM OSTER, EILEEN (OT/L)
Entity type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:
Last Name:SUYDAM OSTER
Suffix:
Gender:F
Credentials:OT/L
Other - Prefix:MS
Other - First Name:EILEEN
Other - Middle Name:F
Other - Last Name:SUYDAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OT/L
Mailing Address - Street 1:2803 BAYBERRY PATH
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-7202
Mailing Address - Country:US
Mailing Address - Phone:917-453-8130
Mailing Address - Fax:
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BUILDING NUMBER, 18 , SUITE B
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-475-1224
Practice Address - Fax:631-475-1588
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003110225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation