Provider Demographics
NPI:1386116374
Name:BABCOCK, ANTHONY NICHOLAS (COTA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:NICHOLAS
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 EVERETT PL
Mailing Address - Street 2:
Mailing Address - City:MAYBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12543-1121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LARKIN PLZ
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-7081
Practice Address - Country:US
Practice Address - Phone:845-275-7890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009968-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009968-1OtherNYS LICENSE