MEDICARE: GEORGE NICHOLAS VENEZIANO 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	0086791	NY

General Provider Information

NPI Number	:	1124107479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE NICHOLAS VENEZIANO OTR L

Provider Business Mailing Address
First Line	:	103 FRANKLIN AVE
Second Line	:
City	:	KEANSBURG
State	:	NJ
Zip	:	07734-3145
Country	:	US
Telephone Number	:	732-769-2447
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 FRANKLIN AVE
Second Line	:
City	:	KEANSBURG
State	:	NJ
Zip	:	07734-3145
Country	:	US
Telephone Number	:	732-769-2447
Fax Number	:

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	10/31/2008

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