Provider Demographics
NPI:1437930021
Name:WOLDER, SYDNEY (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:WOLDER
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 1:2953 CARLYLE RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1708
Mailing Address - Country:US
Mailing Address - Phone:516-477-2976
Mailing Address - Fax:
Practice Address - Street 1:483 CLERMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-2253
Practice Address - Country:US
Practice Address - Phone:191-769-7646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028363-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist