Provider Demographics
NPI:1144604885
Name:NISSANOV-POZILOV, YAFIT (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:YAFIT
Middle Name:
Last Name:NISSANOV-POZILOV
Suffix:
Gender:F
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 1:14732 72ND RD # APART2D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2566
Mailing Address - Country:US
Mailing Address - Phone:718-300-2707
Mailing Address - Fax:
Practice Address - Street 1:200 WINSTON DR APT 718
Practice Address - Street 2:
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3214
Practice Address - Country:US
Practice Address - Phone:201-888-0573
Practice Address - Fax:718-233-9688
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XP0200X
NY023701225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics