Provider Demographics
NPI:1750991089
Name:GURUNG, ISHA (OTR/L)
Entity type:Individual
Prefix:
First Name:ISHA
Middle Name:
Last Name:GURUNG
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 1:9905 63RD DR APT 5P
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2403
Mailing Address - Country:US
Mailing Address - Phone:718-696-7511
Mailing Address - Fax:
Practice Address - Street 1:9905 63RD DR APT 5P
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2403
Practice Address - Country:US
Practice Address - Phone:718-696-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-02
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency