Provider Demographics
NPI:1750935896
Name:RETIG, YUDIS (OTR)
Entity type:Individual
Prefix:
First Name:YUDIS
Middle Name:
Last Name:RETIG
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:RETIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:295 BENNETT AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2490
Mailing Address - Country:US
Mailing Address - Phone:610-308-4390
Mailing Address - Fax:
Practice Address - Street 1:475 W 155TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-6304
Practice Address - Country:US
Practice Address - Phone:212-690-3014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023367-1225XP0019X, 225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics