Provider Demographics
NPI:1669973699
Name:BARAN, DINA CHAYA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DINA
Middle Name:CHAYA
Last Name:BARAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2626
Mailing Address - Country:US
Mailing Address - Phone:646-717-4662
Mailing Address - Fax:
Practice Address - Street 1:1400 PINE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4963
Practice Address - Country:US
Practice Address - Phone:732-534-7325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00789300225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1290398903OtherUNITED HEALTHCARE-OXFORD
NJ112077775Medicaid