Healthcare Provider Details

I. General information

NPI: 1013846195
Provider Name (Legal Business Name): JUSTINE LUONG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 DAVID ST
STATEN ISLAND NY
10308-3118
US

IV. Provider business mailing address

89 DAVID ST
STATEN ISLAND NY
10308-3118
US

V. Phone/Fax

Practice location:
  • Phone: 347-859-1369
  • Fax:
Mailing address:
  • Phone: 347-859-1369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: