Provider Demographics
NPI:1942762166
Name:MASLAVI, JACLYN
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:MASLAVI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BLACKHEATH RD
Mailing Address - Street 2:
Mailing Address - City:LIDO BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4805
Mailing Address - Country:US
Mailing Address - Phone:516-382-0764
Mailing Address - Fax:
Practice Address - Street 1:21 BLACKHEATH RD
Practice Address - Street 2:
Practice Address - City:LIDO BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4805
Practice Address - Country:US
Practice Address - Phone:516-382-0764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist