Healthcare Provider Details

I. General information

NPI: 1144056011
Provider Name (Legal Business Name): PENINA BARUCH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 BROAD ST
CLIFTON NJ
07013-3346
US

IV. Provider business mailing address

25 AMSTERDAM AVE
PASSAIC NJ
07055-3308
US

V. Phone/Fax

Practice location:
  • Phone: 973-574-8585
  • Fax:
Mailing address:
  • Phone: 862-591-4056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number46TR01200500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: