Healthcare Provider Details

I. General information

NPI: 1477049807
Provider Name (Legal Business Name): ITKIN OCCUPATIONAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 MACKENZIE STREET
BROOKLYN NY
11235
US

IV. Provider business mailing address

134 MACKENZIE STREET
BROOKLYN NY
11235
US

V. Phone/Fax

Practice location:
  • Phone: 917-696-2478
  • Fax:
Mailing address:
  • Phone: 917-696-2478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number019938-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number019938-1
License Number StateNY

VIII. Authorized Official

Name: MRS. ERICA FAY ITKIN
Title or Position: OTR/L
Credential: OTR/L
Phone: 917-696-2478