Provider Demographics
NPI:1558486605
Name:SIGNATURE HAND THERAPY O.T. P.C.
Entity type:Organization
Organization Name:SIGNATURE HAND THERAPY O.T. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMETRIOU
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL CHT
Authorized Official - Phone:631-206-3130
Mailing Address - Street 1:1555 SUNRISE HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6027
Mailing Address - Country:US
Mailing Address - Phone:631-206-3130
Mailing Address - Fax:631-206-3148
Practice Address - Street 1:1555 SUNRISE HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6027
Practice Address - Country:US
Practice Address - Phone:631-206-3130
Practice Address - Fax:631-206-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007141-1225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX PAYER ID
NYQT5391Medicare PIN
NY=========OtherTAX PAYER ID