Provider Demographics
NPI:1366985350
Name:PARUBRUB, JOY LAZO (COTA)
Entity type:Individual
Prefix:MS
First Name:JOY
Middle Name:LAZO
Last Name:PARUBRUB
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 1:3548 33RD ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2217
Mailing Address - Country:US
Mailing Address - Phone:310-869-2006
Mailing Address - Fax:
Practice Address - Street 1:1111 44TH RD # 402
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5115
Practice Address - Country:US
Practice Address - Phone:718-433-4434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0086781224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant