MEDICARE: INNA LEYDERMAN OTR

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	225XP0200X	Pediatric Occupational Therapist	P82009	NY

General Provider Information

NPI Number	:	1154670941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNA LEYDERMAN OTR

Provider Business Mailing Address
First Line	:	470 VANDERBILT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2212
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 VANDERBILT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11238-2212
Country	:	US
Telephone Number	:	718-643-5300
Fax Number	:	718-643-0640

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

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	09/07/2012

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Directions to “ INNA LEYDERMAN OTR” Practice Location

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