Healthcare Provider Details

I. General information

NPI: 1972277218
Provider Name (Legal Business Name): JOSEL TUKAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 PROSPECT AVE STE LG
HACKENSACK NJ
07601-2539
US

IV. Provider business mailing address

81 BROOKDALE GDNS APT B
BLOOMFIELD NJ
07003-6385
US

V. Phone/Fax

Practice location:
  • Phone: 201-968-0303
  • Fax:
Mailing address:
  • Phone: 862-285-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number46TA09208700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: