Provider Demographics
NPI:1811599574
Name:CHENG, IVY (OT)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:CHENG
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-2524
Mailing Address - Country:US
Mailing Address - Phone:718-377-5000
Mailing Address - Fax:718-377-5002
Practice Address - Street 1:1538 79TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2524
Practice Address - Country:US
Practice Address - Phone:718-377-5000
Practice Address - Fax:718-377-5002
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist