MEDICARE: MRS. HAYDEE PONDAR 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	225XP0019X	Physical Rehabilitation Occupational Therapist	013832	NY

General Provider Information

NPI Number	:	1609013465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HAYDEE PONDAR OTR/L

Provider Business Mailing Address
First Line	:	7064 YELLOWSTONE BLVD
Second Line	:	APT 1 B
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-3563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	260 MIDDLE COUNTRY RD
Second Line	:	BLDG 3 SUITE 9 A
City	:	SELDEN
State	:	NY
Zip	:	11784-2568
Country	:	US
Telephone Number	:	631-732-1600
Fax Number	:

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

Provider Enumeration Date	:	01/15/2009
Last Update Date	:	06/30/2010

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