Provider Demographics
NPI:1124107479
Name:VENEZIANO, GEORGE NICHOLAS (OTR L)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:NICHOLAS
Last Name:VENEZIANO
Suffix:
Gender:M
Credentials:OTR L
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:NICHOLAS
Other - Last Name:VENEZIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:103 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:KEANSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:07734-3145
Mailing Address - Country:US
Mailing Address - Phone:732-769-2447
Mailing Address - Fax:
Practice Address - Street 1:103 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:KEANSBURG
Practice Address - State:NJ
Practice Address - Zip Code:07734-3145
Practice Address - Country:US
Practice Address - Phone:732-769-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0086791225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist