Healthcare Provider Details

I. General information

NPI: 1386589364
Provider Name (Legal Business Name): LIOR NISSANIAN OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 BAYCHESTER AVE
BRONX NY
10475-1702
US

IV. Provider business mailing address

143 POWERHOUSE RD
ROSLYN HEIGHTS NY
11577-1915
US

V. Phone/Fax

Practice location:
  • Phone: 917-742-9850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number548412
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: