Provider Demographics
NPI:1528681590
Name:BISA, BIANCA BANAGA (OTTH-MA,OTR/L)
Entity type:Individual
Prefix:MS
First Name:BIANCA
Middle Name:BANAGA
Last Name:BISA
Suffix:
Gender:F
Credentials:OTTH-MA,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CEDARLAWN BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2001
Mailing Address - Country:US
Mailing Address - Phone:347-821-7287
Mailing Address - Fax:516-612-2894
Practice Address - Street 1:27 CEDARLAWN BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2001
Practice Address - Country:US
Practice Address - Phone:347-821-7287
Practice Address - Fax:516-612-2894
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-25
Last Update Date:2020-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022107225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist