Provider Demographics
NPI:1720358385
Name:PICHARDO, FERNANDO (COTA)
Entity Type:Individual
Prefix:
First Name:FERNANDO
Middle Name:
Last Name:PICHARDO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W 148TH ST
Mailing Address - Street 2:04
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-3903
Mailing Address - Country:US
Mailing Address - Phone:646-363-4020
Mailing Address - Fax:
Practice Address - Street 1:402 W 148TH ST
Practice Address - Street 2:04
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-3903
Practice Address - Country:US
Practice Address - Phone:646-363-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003100224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant