Provider Demographics
NPI:1942454855
Name:BURDEOS, RENATO D (OTR)
Entity Type:Individual
Prefix:MR
First Name:RENATO
Middle Name:D
Last Name:BURDEOS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153-48 78TH. RD.
Mailing Address - Street 2:#B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-219-5785
Mailing Address - Fax:718-969-7272
Practice Address - Street 1:153-48 78TH. RD.
Practice Address - Street 2:#B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367
Practice Address - Country:US
Practice Address - Phone:718-219-5785
Practice Address - Fax:718-969-7272
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008368-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics