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General NPI Number Information
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NPI Number | 1023570124
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Entity Type | Individual
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Provider Name | JILLIAN SORRENTINO
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Gender | Female
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Dates
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Enumeration Date | 04/05/2019
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Last Update Date | 04/05/2019
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Provider Practice Location Address
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Address Line | 160 LAWRENCE AVE
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City | BROOKLYN
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State | NY
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Zip | 11230-1103
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Country | US
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Telephone | 718-437-3794
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 ROUTE 35 N APT 3
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City | SEASIDE HEIGHTS
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State | NJ
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Zip | 08751-1279
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Country | US
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Telephone | 201-602-9283
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 023509
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License Number State | NY
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