Provider Demographics
NPI:1447205422
Name:MENDELSOHN, NAOMI I (OTR)
Entity Type:Individual
Prefix:MS
First Name:NAOMI
Middle Name:I
Last Name:MENDELSOHN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 59TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1202
Mailing Address - Country:US
Mailing Address - Phone:212-821-9266
Mailing Address - Fax:212-821-9710
Practice Address - Street 1:111 E 59TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1202
Practice Address - Country:US
Practice Address - Phone:212-821-9266
Practice Address - Fax:212-821-9710
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000229-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQT6641Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER