Healthcare Provider Details

I. General information

NPI: 1265397400
Provider Name (Legal Business Name): ZENTS KUNLE SOWUNMI COTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HEMLOCK DR
MASTIC BEACH NY
11951-3706
US

IV. Provider business mailing address

80 HEMLOCK DR
MASTIC BEACH NY
11951-3706
US

V. Phone/Fax

Practice location:
  • Phone: 718-864-7444
  • Fax:
Mailing address:
  • Phone: 718-864-7444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number007327
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: