Provider Demographics
NPI:1154878973
Name:EPSHTEYN, NADEZHDA (COTA)
Entity type:Individual
Prefix:
First Name:NADEZHDA
Middle Name:
Last Name:EPSHTEYN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10500 SHORE FRONT PKWY
Mailing Address - Street 2:APT.5 G
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2785
Mailing Address - Country:US
Mailing Address - Phone:718-702-8319
Mailing Address - Fax:
Practice Address - Street 1:10500 SHORE FRONT PKWY
Practice Address - Street 2:APT.5 G
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2785
Practice Address - Country:US
Practice Address - Phone:718-702-8319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008615-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY741910735-00OtherFIDELIS CARE