Provider Demographics
NPI:1194082065
Name:SIROTA, GEORGIY (OTR/L)
Entity type:Individual
Prefix:
First Name:GEORGIY
Middle Name:
Last Name:SIROTA
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 1:1225 MCBRIDE AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3813
Mailing Address - Country:US
Mailing Address - Phone:973-339-9902
Mailing Address - Fax:
Practice Address - Street 1:1225 MCBRIDE AVE STE 203
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-3813
Practice Address - Country:US
Practice Address - Phone:973-339-9902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026689225X00000X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist