Provider Demographics
NPI:1124225636
Name:GINESE, MARYJO (OT)
Entity type:Individual
Prefix:
First Name:MARYJO
Middle Name:
Last Name:GINESE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15620 RIVERSIDE DR W
Mailing Address - Street 2:#11K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-7010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15620 RIVERSIDE DR W
Practice Address - Street 2:#11K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-7010
Practice Address - Country:US
Practice Address - Phone:212-568-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist