MEDICARE: JHEYSON GUIDO DANLASKY OTA

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	010362-01	NY

General Provider Information

NPI Number	:	1609494475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHEYSON GUIDO DANLASKY OTA

Provider Business Mailing Address
First Line	:	421 PARK PL APT 5J
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-3759
Country	:	US
Telephone Number	:	551-404-2364
Fax Number	:

Provider Business Practice Location Address
First Line	:	421 PARK PL APT 5J
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-3759
Country	:	US
Telephone Number	:	551-404-2364
Fax Number	:

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

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/08/2020

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