Provider Demographics
NPI:1093324204
Name:ZORDAN, ROBERT (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:ZORDAN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 30TH DR APT 3P
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2709
Mailing Address - Country:US
Mailing Address - Phone:718-612-2462
Mailing Address - Fax:
Practice Address - Street 1:2519 30TH DR APT 3P
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2709
Practice Address - Country:US
Practice Address - Phone:718-612-2462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024725225X00000X
CT5501225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty