Healthcare Provider Details

I. General information

NPI: 1447391099
Provider Name (Legal Business Name): ROSALIE MENDUNI M.A. OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

898 OYSTER BAY RD
EAST NORWICH NY
11732-1051
US

IV. Provider business mailing address

2 CALVERT DR
SYOSSET NY
11791-2905
US

V. Phone/Fax

Practice location:
  • Phone: 516-677-1994
  • Fax:
Mailing address:
  • Phone: 516-677-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number003176-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: