Provider Demographics
NPI:1417264920
Name:JASIENOWSKI, SONJA M (MS, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:SONJA
Middle Name:M
Last Name:JASIENOWSKI
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 W 24TH ST
Mailing Address - Street 2:APARTMENT - 5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1504
Mailing Address - Country:US
Mailing Address - Phone:212-204-7313
Mailing Address - Fax:
Practice Address - Street 1:610 W 112TH ST
Practice Address - Street 2:ROOM 218
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1898
Practice Address - Country:US
Practice Address - Phone:212-875-4611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011560-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist