Healthcare Provider Details

I. General information

NPI: 1730647637
Provider Name (Legal Business Name): ALEX KURUVILLA OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2019
Last Update Date: 03/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

350 LAKE AVE
STATEN ISLAND NY
10303-2610
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9000
  • Fax:
Mailing address:
  • Phone: 646-327-9811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number020241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: