Provider Demographics
NPI:1467865899
Name:JOSEPHSON, PASCALE TATIANA (MSED, MSOT, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:PASCALE
Middle Name:TATIANA
Last Name:JOSEPHSON
Suffix:
Gender:F
Credentials:MSED, MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WEST 42ND STREET
Mailing Address - Street 2:APT. 25J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036
Mailing Address - Country:US
Mailing Address - Phone:917-363-3304
Mailing Address - Fax:
Practice Address - Street 1:450 WEST 42ND STREET
Practice Address - Street 2:APT. 25J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036
Practice Address - Country:US
Practice Address - Phone:917-363-3304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024832225X00000X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist