Provider Demographics
NPI:1477049807
Name:ITKIN OCCUPATIONAL THERAPY PC
Entity Type:Organization
Organization Name:ITKIN OCCUPATIONAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR/L
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:FAY
Authorized Official - Last Name:ITKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:917-696-2478
Mailing Address - Street 1:134 MACKENZIE STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:917-696-2478
Mailing Address - Fax:
Practice Address - Street 1:134 MACKENZIE STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:917-696-2478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019938-1252Y00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility