Provider Demographics
NPI:1396037792
Name:ANTONY, MARY SUJA (BSC OT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:SUJA
Last Name:ANTONY
Suffix:
Gender:F
Credentials:BSC OT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:SUJA
Other - Last Name:ANTONY-ARORA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSC OT
Mailing Address - Street 1:731 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3532
Mailing Address - Country:US
Mailing Address - Phone:201-444-0747
Mailing Address - Fax:
Practice Address - Street 1:154 W 93RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7530
Practice Address - Country:US
Practice Address - Phone:212-222-1455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008788-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist