Basic Information
| Provider Information | |||||||||
| NPI: | 1265584114 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELGADO | ||||||||
| FirstName: | JUANITA | ||||||||
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| Credential: | C.O.T.A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25110 ELKMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BELLEROSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114262635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9176267271 | ||||||||
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| Practice Location | |||||||||
| Address1: | 179 ST. LINDEN BLVD. | ||||||||
| Address2: | |||||||||
| City: | ST.ALBANS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185261000 | ||||||||
| FaxNumber: | 7182988520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 224Z00000X | 002540-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.