1144530221 NPI number — MRS. RABA SILJKOVIC OCCUPATIONAL THERAPI

Table of content: MRS. RABA SILJKOVIC OCCUPATIONAL THERAPI (NPI 1144530221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144530221 NPI number — MRS. RABA SILJKOVIC OCCUPATIONAL THERAPI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILJKOVIC
Provider First Name:
RABA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OCCUPATIONAL THERAPI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144530221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
249 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-561-0670
Provider Business Mailing Address Fax Number:
845-561-9456

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
379 MOUNT HOPE RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-344-2292
Provider Business Practice Location Address Fax Number:
845-342-2054
Provider Enumeration Date:
10/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  007148-1 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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