MEDICARE: SIR VAUGHN JOFFRE AINZA LACSAMANA

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

General Provider Information

NPI Number	:	1467300848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIR VAUGHN JOFFRE AINZA LACSAMANA

Provider Business Mailing Address
First Line	:	216 WASHINGTON AVE
Second Line	:
City	:	LITTLE FERRY
State	:	NJ
Zip	:	07643-2076
Country	:	US
Telephone Number	:	201-620-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	216 WASHINGTON AVE
Second Line	:
City	:	LITTLE FERRY
State	:	NJ
Zip	:	07643-2076
Country	:	US
Telephone Number	:	201-620-6200
Fax Number	:

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

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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Directions to “ SIR VAUGHN JOFFRE AINZA LACSAMANA ” Practice Location

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