Healthcare Provider Details

I. General information

NPI: 1629962287
Provider Name (Legal Business Name): JACKELINE RAMIREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2025
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 MAINE AVE
ROCKVILLE CENTRE NY
11570-3614
US

IV. Provider business mailing address

71 W OAKDALE ST
BAY SHORE NY
11706-2630
US

V. Phone/Fax

Practice location:
  • Phone: 516-536-7730
  • Fax:
Mailing address:
  • Phone: 347-453-3469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number005770-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: