Provider Demographics
NPI:1306497300
Name:ONG, ELIZA ARANETA (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:ARANETA
Last Name:ONG
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 ELMWOOD AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14207-2469
Mailing Address - Country:US
Mailing Address - Phone:914-263-0904
Mailing Address - Fax:
Practice Address - Street 1:777 MARYVALE DR
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2712
Practice Address - Country:US
Practice Address - Phone:716-631-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023828225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist