Provider Demographics
NPI:1720201171
Name:JOSAN, NAVDEEP KAUR (OTRL CHT)
Entity Type:Individual
Prefix:
First Name:NAVDEEP
Middle Name:KAUR
Last Name:JOSAN
Suffix:
Gender:F
Credentials:OTRL CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NORTHERN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5206
Mailing Address - Country:US
Mailing Address - Phone:516-627-8717
Mailing Address - Fax:516-684-2683
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5206
Practice Address - Country:US
Practice Address - Phone:516-627-8717
Practice Address - Fax:516-684-2683
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008988225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQS749ES693Medicare PIN