Provider Demographics
NPI:1497208276
Name:AGOSTINI, PAUL (OTR)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:AGOSTINI
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 GRAND CONCOURSE
Mailing Address - Street 2:APT 7L
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-2814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:860 GRAND CONCOURSE
Practice Address - Street 2:APT 7L
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-2814
Practice Address - Country:US
Practice Address - Phone:845-661-8759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020615225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist