Healthcare Provider Details

I. General information

NPI: 1700082252
Provider Name (Legal Business Name): MAYURA KANEKAR OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 212TH ST
BAYSIDE NY
11361-2035
US

IV. Provider business mailing address

3802 212TH ST
BAYSIDE NY
11361-2035
US

V. Phone/Fax

Practice location:
  • Phone: 917-859-5856
  • Fax:
Mailing address:
  • Phone: 917-859-5856
  • Fax: 917-859-5856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number009679
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: