Provider Demographics
NPI:1003128661
Name:BURSTEIN, RAYA (OT)
Entity Type:Individual
Prefix:MS
First Name:RAYA
Middle Name:
Last Name:BURSTEIN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:ROSEMARY
Other - Middle Name:DIANE
Other - Last Name:MOULDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13842 76TH AVE
Mailing Address - Street 2:NONE
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2820
Mailing Address - Country:US
Mailing Address - Phone:718-261-7392
Mailing Address - Fax:
Practice Address - Street 1:13842 76TH AVE
Practice Address - Street 2:NONE
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2820
Practice Address - Country:US
Practice Address - Phone:718-261-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-11
Last Update Date:2010-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007762-1101Y00000X, 101YM0800X, 103K00000X, 1041C0700X, 156FX1900X, 172V00000X, 247ZC0005X
NY00762-1173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptist
No172V00000XOther Service ProvidersCommunity Health Worker
No173C00000XOther Service ProvidersReflexologist
No247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid
NY$$$$$$$$$Medicare UPIN