Healthcare Provider Details

I. General information

NPI: 1356673875
Provider Name (Legal Business Name): RIVKA FISHMAN OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HADASSAH LN
LAKEWOOD NJ
08701-5559
US

IV. Provider business mailing address

112 HADASSAH LN
LAKEWOOD NJ
08701-5559
US

V. Phone/Fax

Practice location:
  • Phone: 732-833-3723
  • Fax: 732-942-8848
Mailing address:
  • Phone: 732-833-3723
  • Fax: 732-942-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00359300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: