Provider Demographics
NPI:1093023913
Name:IACOVETTA, ELEANOR
Entity Type:Individual
Prefix:MRS
First Name:ELEANOR
Middle Name:
Last Name:IACOVETTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48A BURDA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-1420
Mailing Address - Country:US
Mailing Address - Phone:845-638-9103
Mailing Address - Fax:
Practice Address - Street 1:48A BURDA AVE
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-1420
Practice Address - Country:US
Practice Address - Phone:845-638-9103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005021-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant