Basic Information
Provider Information | |||||||||
NPI: | 1942490347 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DACIUK | ||||||||
FirstName: | BARBARA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | COTA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | INNOCENTI | ||||||||
OtherFirstName: | BARBARA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | MRS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | COTA | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 27 AUGUSTA RD | ||||||||
Address2: |   | ||||||||
City: | WHITING | ||||||||
State: | NJ | ||||||||
PostalCode: | 087592237 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7328495063 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 220 WHITE PLAINS RD | ||||||||
Address2: | SUITE 550 | ||||||||
City: | TARRYTOWN | ||||||||
State: | NY | ||||||||
PostalCode: | 105915837 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9146319020 | ||||||||
FaxNumber: | 9146319028 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/31/2007 | ||||||||
LastUpdateDate: | 07/31/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 46TA09020700 | NJ | Y |   | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |   |
No ID Information.