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General NPI Number Information
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NPI Number | 1053470864
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Entity Type | Individual
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Provider Name | JENNIFER LYNN DULEK OTRL
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Gender | Female
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 411 W 114TH ST SUITE 4C
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City | NEW YORK
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State | NY
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Zip | 10025-1710
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Country | US
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Telephone | 212-523-4110
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Fax | 212-523-4911
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Provider Business Mailing Address
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Address Line | 2525 14TH ST APT. 2F
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City | ASTORIA
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State | NY
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Zip | 11102-3720
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Country | US
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Telephone | 718-777-6540
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 013236
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License Number State | NY
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