MEDICARE: LOISMARIE DANGAZO CONDEZA

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

General Provider Information

NPI Number	:	1649100330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOISMARIE DANGAZO CONDEZA

Provider Business Mailing Address
First Line	:	2580 SCHURZ AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-3140
Country	:	US
Telephone Number	:	646-418-8364
Fax Number	:	646-418-8364

Provider Business Practice Location Address
First Line	:	2580 SCHURZ AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10465-3140
Country	:	US
Telephone Number	:	646-418-8364
Fax Number	:	646-418-8364

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

Provider Enumeration Date	:	05/22/2026
Last Update Date	:	05/22/2026

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