Provider Demographics
NPI:1902416456
Name:UMAROV, ZOKIRJON (ORT/L)
Entity Type:Individual
Prefix:
First Name:ZOKIRJON
Middle Name:
Last Name:UMAROV
Suffix:
Gender:M
Credentials:ORT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 CONEY ISLAND AVE APT 6C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6613
Mailing Address - Country:US
Mailing Address - Phone:646-675-4795
Mailing Address - Fax:
Practice Address - Street 1:3250 CONEY ISLAND AVE APT 6C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6613
Practice Address - Country:US
Practice Address - Phone:646-675-4795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist