1831469626 NPI number — KIDAPILLAR OCCUPATIONAL THERAPY, PC

Table of content: DR. NACHUM SHALOM OZERI D.O. (NPI 1992120356)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831469626 NPI number — KIDAPILLAR OCCUPATIONAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDAPILLAR OCCUPATIONAL THERAPY, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1831469626
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
258-05 PEMBROKE AVE.,
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT NECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-813-4770
Provider Business Mailing Address Fax Number:
516-482-1257

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
149-23 SANFORD AVE.,
Provider Second Line Business Practice Location Address:
SUITE A1
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-813-4770
Provider Business Practice Location Address Fax Number:
516-482-1257
Provider Enumeration Date:
01/10/2012

Additional Information

Authorized Official

Authorized Official Last Name:
TSANG
Authorized Official First Name:
FLORA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
718-813-4770

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  005017 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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