Provider Demographics
NPI:1720524697
Name:RUBINOVA, SUSANA (COTA/L)
Entity Type:Individual
Prefix:
First Name:SUSANA
Middle Name:
Last Name:RUBINOVA
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6259 108TH ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1314
Mailing Address - Country:US
Mailing Address - Phone:917-557-9903
Mailing Address - Fax:
Practice Address - Street 1:6259 108TH ST APT 5F
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1314
Practice Address - Country:US
Practice Address - Phone:917-557-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY352474224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant