MEDICARE: JENNY OCCIANO

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	225100000X	Physical Therapist	039222	NY
2	225200000X	Physical Therapy Assistant	008294	NY

General Provider Information

NPI Number	:	1932554698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY OCCIANO

Provider Business Mailing Address
First Line	:	4015 81ST STREET, APT A49
Second Line	:	ELMHURST
City	:	NEW YORK
State	:	NY
Zip	:	11373
Country	:	US
Telephone Number	:	551-265-5872
Fax Number	:

Provider Business Practice Location Address
First Line	:	4015 81ST STREET, APT A49
Second Line	:	ELMHURST
City	:	NEW YORK
State	:	NY
Zip	:	11373
Country	:	US
Telephone Number	:	551-265-5872
Fax Number	:

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

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/02/2016

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Directions to “ JENNY OCCIANO ” Practice Location

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