Provider Demographics
NPI:1215181060
Name:SAMOJEDNY, BOZENA LUCYNA (OTA)
Entity Type:Individual
Prefix:MRS
First Name:BOZENA
Middle Name:LUCYNA
Last Name:SAMOJEDNY
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5933 60TH RD
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-3515
Mailing Address - Country:US
Mailing Address - Phone:917-622-4473
Mailing Address - Fax:718-497-4848
Practice Address - Street 1:5933 60TH RD
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-3515
Practice Address - Country:US
Practice Address - Phone:917-622-4473
Practice Address - Fax:718-497-4848
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006177224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant