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General NPI Number Information
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NPI Number | 1770241754
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Entity Type | Organization
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Legal Business Name | MAISEY NISIMOV OCCUPATIONAL THERAPIST
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 22 SCHRADIN HL
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City | GREENWOOD LAKE
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State | NY
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Zip | 10925-4109
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Country | US
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Telephone | 347-209-8282
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Fax |
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Provider Business Mailing Address
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Address Line | 7602 UTOPIA PKWY
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City | FRESH MEADOWS
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State | NY
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Zip | 11366-1518
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Country | US
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Telephone | 347-209-8282
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAISEY NISIMOV
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Credential |
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Telephone | 347-209-8282
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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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