Provider Demographics
NPI:1598077794
Name:PINUNGGAN, MARION
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:PINUNGGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 W 135TH ST
Mailing Address - Street 2:LENOX REHABILITATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030
Mailing Address - Country:US
Mailing Address - Phone:212-281-8678
Mailing Address - Fax:212-281-8677
Practice Address - Street 1:131 W 135TH ST
Practice Address - Street 2:LENOX REHABILITATION
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030
Practice Address - Country:US
Practice Address - Phone:212-281-8678
Practice Address - Fax:212-281-8677
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015278225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist