Provider Demographics
NPI:1447422480
Name:VONBUJDOSS, MARTHA (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:VONBUJDOSS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 ST MARKS AVENUE, #2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1583
Mailing Address - Country:US
Mailing Address - Phone:917-847-4142
Mailing Address - Fax:
Practice Address - Street 1:871 SAINT MARKS AVE APT 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1583
Practice Address - Country:US
Practice Address - Phone:917-847-4142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003321-1171100000X
NY009106-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009106OtherLINCESE #
NY003321-1OtherLICENSE #