Provider Demographics
NPI:1013363936
Name:RISHA PORTOWICZ
Entity Type:Organization
Organization Name:RISHA PORTOWICZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:917-453-1119
Mailing Address - Street 1:750 FOREST AVE APT 46F
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2741
Mailing Address - Country:US
Mailing Address - Phone:917-453-1119
Mailing Address - Fax:
Practice Address - Street 1:750 FOREST AVE APT 46F
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2741
Practice Address - Country:US
Practice Address - Phone:917-453-1119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty