Provider Demographics
NPI:1528280518
Name:CONK, JANET (MS OTRL)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:CONK
Suffix:
Gender:F
Credentials:MS OTRL
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:
Other - Last Name:ZGOMBIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTRL
Mailing Address - Street 1:1631 GILFORD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1943 HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VT
Practice Address - Zip Code:05477
Practice Address - Country:US
Practice Address - Phone:516-435-3425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0720000483225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist