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General NPI Number Information
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NPI Number | 1275338063
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Entity Type | Individual
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Provider Name | ENMANUEL MOISES ANTONIO BENCOSME ALEJO OTR
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Gender | Male
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Dates
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Enumeration Date | 02/15/2025
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Last Update Date | 02/15/2025
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Provider Practice Location Address
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Address Line | 1051 RIVERSIDE DR
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City | NEW YORK
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State | NY
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Zip | 10032-1007
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Country | US
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Telephone | 646-774-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 50 HAVEN AVE # 92
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City | NEW YORK
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State | NY
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Zip | 10032-2652
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Country | US
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Telephone | 347-841-4147
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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 | 225XM0800X
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Taxonomy Name | Mental Health Occupational Therapist
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License Number | 029796
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License Number State | NY
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