Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 019651 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 019651 | NY |
NPI | 1063809150 |
---|---|
Provider Name | Susan Josipovich |
First Address | Brooklyn, NY 11230-6604 |
Second Address | Brooklyn, NY 11204-5703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 16/04/2015 |