MEDICARE: WILSON AYZENBERG OT PC

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	:	1972310365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON AYZENBERG OT PC

Provider Business Mailing Address
First Line	:	386 17TH ST APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6122
Country	:	US
Telephone Number	:	347-753-4446
Fax Number	:

Provider Business Practice Location Address
First Line	:	386 17TH ST APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6122
Country	:	US
Telephone Number	:	347-753-4446
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	WILSON DAVID AYZENBERG
Credential	:
Telephone Number	:	347-753-4446

Provider Enumeration Date	:	12/18/2024
Last Update Date	:	12/18/2024

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