Basic Information
| Provider Information | |||||||||
| NPI: | 1114430642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VIRASAWMI | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | M.A, ATR-BC,LCAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 FIG ST | ||||||||
| Address2: | |||||||||
| City: | CENTRAL ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117224002 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4419 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104572562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183647700 | ||||||||
| FaxNumber: | 7183641513 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/06/2017 | ||||||||
| LastUpdateDate: | 12/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZA2600X | 002036 | NY | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Art, Medical |
No ID Information.