Healthcare Provider Details

I. General information

NPI: 1407569882
Provider Name (Legal Business Name): JENNIFER BUENING OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 01/02/2023
Certification Date: 01/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3391 RICHMOND AVE
STATEN ISLAND NY
10312-2025
US

IV. Provider business mailing address

239 E 79TH ST APT 6H
NEW YORK NY
10075-0813
US

V. Phone/Fax

Practice location:
  • Phone: 718-608-9170
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: