Provider Demographics
NPI:1083083539
Name:BIGORNIA, ANTHONY KAHRL (OT)
Entity Type:Individual
Prefix:
First Name:ANTHONY KAHRL
Middle Name:
Last Name:BIGORNIA
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 231ST ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2107
Mailing Address - Country:US
Mailing Address - Phone:646-236-6898
Mailing Address - Fax:
Practice Address - Street 1:444 WILLIS AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4013
Practice Address - Country:US
Practice Address - Phone:646-236-6898
Practice Address - Fax:570-729-7242
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019768-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06841845Medicaid