Basic Information
Provider Information
NPI: 1124604392
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEISER
FirstName: TAYLOR
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1377 MOTOR PKWY STE 307
Address2:  
City: ISLANDIA
State: NY
PostalCode: 117495258
CountryCode: US
TelephoneNumber: 9142944050
FaxNumber: 6317608306
Practice Location
Address1: 1622 TIMBERWOOD BLVD STE AND211
Address2:  
City: CHARLOTTESVILLE
State: VA
PostalCode: 229117573
CountryCode: US
TelephoneNumber: 4342022830
FaxNumber: 4345298457
Other Information
ProviderEnumerationDate: 03/19/2021
LastUpdateDate: 03/25/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/25/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225X00000X0119008976VAY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 

No ID Information.


Home