Provider Demographics
NPI:1104137223
Name:SWARUP, VIMAL K (OTR/L)
Entity type:Individual
Prefix:
First Name:VIMAL
Middle Name:K
Last Name:SWARUP
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 KISSENA BLVD
Mailing Address - Street 2:19N
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3769
Mailing Address - Country:US
Mailing Address - Phone:917-496-0022
Mailing Address - Fax:718-878-2218
Practice Address - Street 1:4370 KISSENA BLVD
Practice Address - Street 2:19N
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3769
Practice Address - Country:US
Practice Address - Phone:917-496-0022
Practice Address - Fax:718-878-2218
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY11296225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist