Provider Demographics
NPI:1215201819
Name:CRESSY, NIDIA M (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:NIDIA
Middle Name:M
Last Name:CRESSY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:NIDIA
Other - Middle Name:M
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NIDIA M VASQUEZ
Mailing Address - Street 1:46 HARVARD LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2528
Mailing Address - Country:US
Mailing Address - Phone:631-559-4791
Mailing Address - Fax:
Practice Address - Street 1:1065 SMITHTOWN AVE
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-3800
Practice Address - Country:US
Practice Address - Phone:631-567-3113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-28
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016687225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist