Healthcare Provider Details

I. General information

NPI: 1922464932
Provider Name (Legal Business Name): JENALYN ABALOS ALPANO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 01/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

774 MANOR RD SUITE 210
STATEN ISLAND NY
10314-7038
US

IV. Provider business mailing address

160 LABAU AVE
STATEN ISLAND NY
10301-4243
US

V. Phone/Fax

Practice location:
  • Phone: 718-983-0757
  • Fax:
Mailing address:
  • Phone: 917-403-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number017675
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: