Provider Demographics
NPI:1194091397
Name:111-11 118TH STREET OZONE PARK N.Y.
Entity type:Organization
Organization Name:111-11 118TH STREET OZONE PARK N.Y.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MAURA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:TRAINOR
Authorized Official - Suffix:
Authorized Official - Credentials:OT/L
Authorized Official - Phone:718-843-8390
Mailing Address - Street 1:11111 118TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-1220
Mailing Address - Country:US
Mailing Address - Phone:718-843-8390
Mailing Address - Fax:718-641-2474
Practice Address - Street 1:11111 118TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-1220
Practice Address - Country:US
Practice Address - Phone:718-843-8390
Practice Address - Fax:718-641-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004875-1251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services