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General NPI Number Information
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NPI Number | 1467181552
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Entity Type | Individual
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Provider Name | IBADULLAH SHARIFF COTA
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Gender | Male
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Dates
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Enumeration Date | 06/06/2022
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Last Update Date | 06/07/2022
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Provider Practice Location Address
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Address Line | 6800 JERICHO TPKE, SYOSSET, NY 11791
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City | SYOSSET
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State | NY
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Zip | 11791
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Country | US
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Telephone | 909-551-6673
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Fax |
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Provider Business Mailing Address
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Address Line | 188 FLAX HILL RD APT B1
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City | NORWALK
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State | CT
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Zip | 06854-2845
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Country | US
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Telephone | 909-551-6673
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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