Healthcare Provider Details

I. General information

NPI: 1649676255
Provider Name (Legal Business Name): RIVKA FREUNDLICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2014
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LINDA DR
JACKSON NJ
08527-5025
US

IV. Provider business mailing address

15 LINDA DR
JACKSON NJ
08527-5025
US

V. Phone/Fax

Practice location:
  • Phone: 845-642-4266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number46YR00562400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: