Provider Demographics
NPI:1811108962
Name:BAZINI, SHOSHANA TZIPPORAH (PT)
Entity type:Individual
Prefix:MRS
First Name:SHOSHANA
Middle Name:TZIPPORAH
Last Name:BAZINI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 GASTON ST
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3025
Mailing Address - Country:US
Mailing Address - Phone:516-557-1492
Mailing Address - Fax:516-804-8178
Practice Address - Street 1:1390 GASTON ST
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3025
Practice Address - Country:US
Practice Address - Phone:516-557-1492
Practice Address - Fax:516-804-8178
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0243251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist