Provider Demographics
NPI:1366714081
Name:STELLAR PHYSICAL & OCCUPATIONAL THERAPY & ACUPUNCTURE, PLLC
Entity type:Organization
Organization Name:STELLAR PHYSICAL & OCCUPATIONAL THERAPY & ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:WOOLWARD
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:347-512-5674
Mailing Address - Street 1:8709 JUSTICE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4556
Mailing Address - Country:US
Mailing Address - Phone:718-699-5070
Mailing Address - Fax:718-699-5071
Practice Address - Street 1:8709 JUSTICE AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4556
Practice Address - Country:US
Practice Address - Phone:718-699-5070
Practice Address - Fax:718-699-5071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014057225X00000X
NY035391225100000X
NY027453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty