Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 023509 | NY |
NPI | 1023570124 |
---|---|
Provider Name | Jillian Sorrentino |
First Address | Seaside Heights, NJ 08751-1279 |
Second Address | Brooklyn, NY 11230-1103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2019 |
Last Update Date | 05/04/2019 |