Basic Information
| Provider Information | |||||||||
| NPI: | 1366429896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PACHECO | ||||||||
| FirstName: | DENAE | ||||||||
| MiddleName: | GENESIS | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 NEWHAM AVE | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117175624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8003640689 | ||||||||
| FaxNumber: | 8885526176 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 JEROME AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104523301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185388343 | ||||||||
| FaxNumber: | 7185388356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 012422 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.