Provider Demographics
NPI:1992375372
Name:ENERGY RESOLUTION THEORIES, LLC LEAH FAZAL SOLE MBR
Entity Type:Organization
Organization Name:ENERGY RESOLUTION THEORIES, LLC LEAH FAZAL SOLE MBR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAZAL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:718-791-8950
Mailing Address - Street 1:139 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-4726
Mailing Address - Country:US
Mailing Address - Phone:718-791-8950
Mailing Address - Fax:
Practice Address - Street 1:11 IRVING PL
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1256
Practice Address - Country:US
Practice Address - Phone:718-791-8950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty