MEDICARE: MONA A SAMAAN OTRL

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	225XH1200X	Hand Occupational Therapist	0047181	NY

General Provider Information

NPI Number	:	1982695565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONA A SAMAAN OTRL

Provider Business Mailing Address
First Line	:	2535 ARTHUR KILL RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1207
Country	:	US
Telephone Number	:	718-448-3210
Fax Number	:	718-967-6023

Provider Business Practice Location Address
First Line	:	3311 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-3688
Country	:	US
Telephone Number	:	718-448-3210
Fax Number	:	718-967-6017

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

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	06/27/2011

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Directions to “ MONA A SAMAAN OTRL” Practice Location

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