Provider Demographics
NPI:1154384287
Name:STILLWATER OCCUPATIONAL THERAPY & SOCIAL WORK GROUP, PLLC
Entity type:Organization
Organization Name:STILLWATER OCCUPATIONAL THERAPY & SOCIAL WORK GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZYSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-647-7885
Mailing Address - Street 1:160 HOWELLS RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5320
Mailing Address - Country:US
Mailing Address - Phone:631-647-7885
Mailing Address - Fax:631-647-7893
Practice Address - Street 1:160 HOWELLS RD
Practice Address - Street 2:SUITE 2
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5320
Practice Address - Country:US
Practice Address - Phone:631-647-7885
Practice Address - Fax:631-647-7893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02640857Medicaid
NY02640857Medicaid