Healthcare Provider Details

I. General information

NPI: 1285955518
Provider Name (Legal Business Name): JENNIFER L. CUAYCONG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 COMMERCE ST SUITE 120
YORKTOWN HEIGHTS NY
10598-4428
US

IV. Provider business mailing address

20 MERRIE TRL
DENVILLE NJ
07834-1528
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-9020
  • Fax:
Mailing address:
  • Phone: 973-664-1749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00264500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: