Provider Demographics
NPI:1962861211
Name:NOVA OT PC
Entity Type:Organization
Organization Name:NOVA OT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BARDANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-679-2040
Mailing Address - Street 1:9805 63RD RD
Mailing Address - Street 2:5B
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1744
Mailing Address - Country:US
Mailing Address - Phone:917-679-2040
Mailing Address - Fax:
Practice Address - Street 1:9805 63RD RD
Practice Address - Street 2:5B
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1744
Practice Address - Country:US
Practice Address - Phone:917-679-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018931225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty