Healthcare Provider Details

I. General information

NPI: 1215832472
Provider Name (Legal Business Name): MIRIAM MOTECHIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MEDICAL PARK DR
POMONA NY
10970-3525
US

IV. Provider business mailing address

41 HIGHGATE TER
BERGENFIELD NJ
07621-3919
US

V. Phone/Fax

Practice location:
  • Phone: 845-425-5252
  • Fax:
Mailing address:
  • Phone: 201-370-8353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number028111
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: