MEDICARE: RONEN SAMUELS OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	018981	NY

General Provider Information

NPI Number	:	1013319177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONEN SAMUELS OTR/L

Provider Business Mailing Address
First Line	:	3053 HENRY HUDSON PKWY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4700
Country	:	US
Telephone Number	:	917-574-8341
Fax Number	:

Provider Business Practice Location Address
First Line	:	3053 HENRY HUDSON PKWY
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10463-4700
Country	:	US
Telephone Number	:	917-574-8341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2014
Last Update Date	:	09/20/2014

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