MEDICARE: IWONA MEDINA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	025535	NY

General Provider Information

NPI Number	:	1578146528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IWONA MEDINA

Provider Business Mailing Address
First Line	:	99 W HAWTHORNE AVE STE 210
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-6126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 W HAWTHORNE AVE STE 210
Second Line	:
City	:	VALLEY STREAM
State	:	NY
Zip	:	11580-6126
Country	:	US
Telephone Number	:	718-793-3200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2021
Last Update Date	:	01/04/2024

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Directions to “ IWONA MEDINA ” Practice Location

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