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General NPI Number Information
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NPI Number | 1316319486
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Entity Type | Organization
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Legal Business Name | ERLINE SYVRAIN OTA, PC
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Dates
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Enumeration Date | 10/28/2015
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 940 EAST 59TH STREET
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City | BROOKLYN
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State | NY
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Zip | 11234
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Country | US
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Telephone | 347-218-2795
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Fax |
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Provider Business Mailing Address
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Address Line | 940 EAST 59TH STREET
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City | BROOKLYN
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State | NY
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Zip | 11234
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Country | US
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Telephone | 347-218-2795
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Fax |
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Authorized Official
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Title or Position | COTS
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Name | MS. ERLINE SYVRAIN
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Credential | COTA
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Telephone | 347-218-2795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | 008573
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License Number State | NY
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