MEDICARE: MARIAM SAMIR BESHAY

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	224Z00000X	Occupational Therapy Assistant	009932	NY
2	225X00000X	Occupational Therapist	029219-01	NY

General Provider Information

NPI Number	:	1124868823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM SAMIR BESHAY

Provider Business Mailing Address
First Line	:	7856 74TH ST FL AT1
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7428
Country	:	US
Telephone Number	:	347-459-7193
Fax Number	:

Provider Business Practice Location Address
First Line	:	7856 74TH ST
Second Line	:
City	:	GLENDALE
State	:	NY
Zip	:	11385-7428
Country	:	US
Telephone Number	:	347-459-7193
Fax Number	:

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

Provider Enumeration Date	:	05/29/2024
Last Update Date	:	06/21/2024

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