Provider Demographics
NPI:1346777299
Name:HEEGAN-GORODINSKY, CHRISTINE (OTR/L)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HEEGAN-GORODINSKY
Suffix:
Gender:F
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 1:3391 RICHMOND AVE # TPP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-2025
Mailing Address - Country:US
Mailing Address - Phone:718-608-9170
Mailing Address - Fax:718-608-9179
Practice Address - Street 1:3050 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-4901
Practice Address - Country:US
Practice Address - Phone:718-548-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2017-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009334225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics