Provider Demographics
NPI:1225790454
Name:KRUPKA, NAOMI (OTR/L)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:KRUPKA
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 1:528 OAK DR
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-5411
Mailing Address - Country:US
Mailing Address - Phone:917-623-2258
Mailing Address - Fax:
Practice Address - Street 1:1663 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1259
Practice Address - Country:US
Practice Address - Phone:718-338-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist