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General NPI Number Information
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NPI Number | 1134618697
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Entity Type | Individual
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Provider Name | MS. MICHAL BEN-BARUCH
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Gender | Female
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 07/20/2018
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Provider Practice Location Address
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Address Line | 475 W 250TH ST
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City | BRONX
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State | NY
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Zip | 10471-2925
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Country | US
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Telephone | 718-549-4753
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Fax |
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Provider Business Mailing Address
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Address Line | 650 PARK AVE
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City | ELIZABETH
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State | NJ
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Zip | 07208-1351
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Country | US
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Telephone | 908-875-3343
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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 | 224ZE0001X
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Taxonomy Name | Environmental Modification Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | P10219
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number |
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License Number State |
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