Basic Information
Provider Information
NPI: 1205442431
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CLAUSS
FirstName: EMILY
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: DPT, PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1377 MOTOR PKWY STE 307
Address2:  
City: ISLANDIA
State: NY
PostalCode: 117495258
CountryCode: US
TelephoneNumber: 6315805200
FaxNumber: 6317608306
Practice Location
Address1: 210 NORTH AVE E STE 1
Address2:  
City: CRANFORD
State: NJ
PostalCode: 070162491
CountryCode: US
TelephoneNumber: 9082760237
FaxNumber: 9082765692
Other Information
ProviderEnumerationDate: 09/22/2020
LastUpdateDate: 09/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X40QA01937000NJY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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