Provider Demographics
NPI:1932554698
Name:OCCIANO, JENNY
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:OCCIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4015 81ST STREET, APT A49
Mailing Address - Street 2:ELMHURST
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:551-265-5872
Mailing Address - Fax:
Practice Address - Street 1:4015 81ST STREET, APT A49
Practice Address - Street 2:ELMHURST
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:551-265-5872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039222225100000X
NY008294225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant