Provider Demographics
NPI:1780944041
Name:SUSAN E. YOUNG OT PC
Entity type:Organization
Organization Name:SUSAN E. YOUNG OT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:516-582-9034
Mailing Address - Street 1:11 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-8419
Mailing Address - Country:US
Mailing Address - Phone:516-582-9034
Mailing Address - Fax:516-799-1359
Practice Address - Street 1:11 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-8419
Practice Address - Country:US
Practice Address - Phone:516-582-9034
Practice Address - Fax:516-799-1359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005988-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty