Provider Demographics
NPI:1811299332
Name:GLEZER, IRINA (OTR/L)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:GLEZER
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 1:8511 LEFFERTS BLVD APT 3G
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3036
Mailing Address - Country:US
Mailing Address - Phone:917-318-0409
Mailing Address - Fax:
Practice Address - Street 1:12510 QUEENS BLVD APT 1807
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1510
Practice Address - Country:US
Practice Address - Phone:718-544-8771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY63016523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist