Healthcare Provider Details

I. General information

NPI: 1740580638
Provider Name (Legal Business Name): LYNNETTE MARGARET DAGROSA M.A.,O.T.R./L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MATTHEW ANTHONY DAGROSA OTR

II. Dates (important events)

Enumeration Date: 10/26/2010
Last Update Date: 10/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 CARROLL ST APT D3
BROOKLYN NY
11231-3540
US

IV. Provider business mailing address

154 CARROLL ST APT D3
BROOKLYN NY
11231-3540
US

V. Phone/Fax

Practice location:
  • Phone: 718-522-2748
  • Fax:
Mailing address:
  • Phone: 718-522-2748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0021481
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: