Provider Demographics
NPI:1356656052
Name:ROSALIE MENDUNI, DBA, EAST NORWICH THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:ROSALIE MENDUNI, DBA, EAST NORWICH THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDUNI
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:516-677-1994
Mailing Address - Street 1:2 CALVERT DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2905
Mailing Address - Country:US
Mailing Address - Phone:516-677-1994
Mailing Address - Fax:
Practice Address - Street 1:898 OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:EAST NORWICH
Practice Address - State:NY
Practice Address - Zip Code:11732-1051
Practice Address - Country:US
Practice Address - Phone:516-677-1994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003176-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency