Provider Demographics
NPI:1053667618
Name:OCASIO, FREDDY
Entity Type:Individual
Prefix:MR
First Name:FREDDY
Middle Name:
Last Name:OCASIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3363 SEDGWICK AVE APT 1K
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6069
Mailing Address - Country:US
Mailing Address - Phone:347-570-9221
Mailing Address - Fax:
Practice Address - Street 1:3363 SEDGWICK AVE APT 1K
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6069
Practice Address - Country:US
Practice Address - Phone:347-570-9221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY813481252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency