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Organization
SHRUB OAK CLINICAL SERVICES OT, PT, SLP, LMSW, PSYCHOLOGY, PLLC
Active
Organization
SHRUB OAK CLINICAL SERVICES OT, PT, SLP, LMSW, PSYCHOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LORI KOFFLER SLP (PRESIDENT)
(917) 696-2171
Entity
Organization
Contact information
Practice address
80 BROAD ST STE 1702, NEW YORK, NY 10004-2248
(212) 867-2922
Mailing address
80 BROAD ST STE 1702, NEW YORK, NY 10004-2248
(212) 867-2922
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
014220
NY
1041C0700X
Clinical Social Worker
097381
—
225100000X
Physical Therapist
035660
NY
225X00000X
Occupational Therapist
016818
NY
235Z00000X
Speech-Language Pathologist
002141
NY
235Z00000X
Speech-Language Pathologist
Primary
02141
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002141
NEW YORK STATE EDUCATION DEPARTMENT
NY
01
—
014220
NEW YORK STATE EDUCATION DEPARTMENT
NY
01
—
016818
NEW YORK STATE EDUCATION DEPARTMENT
NY
01
—
035660
NEW YORK STATE EDUCATION DEPARTMENT
NY
01
—
097381
NEW YORK STATE EDUCATION DEPARTMENT
NY
Enumeration date
08/17/2018
Last updated
08/17/2018
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