Gerald O Ikezi
Individual provider Active NPI Occupational Therapy Assistant · Addisleigh Park, NY
NPI 1013211515 · NPPES record last updated Dec 27, 2010
Key facts
- NPI
- 1013211515
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapy Assistant 224Z00000X
- License
- 007775-1 (NY)
- Practice address
- 17330 113TH Ave
Addisleigh Park, NY 11433-4003 - Phone
- (718) 207-3292
- NPI assigned
- Dec 27, 2010
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007775-1 | NY | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | 007775-1 | NY | Yes |
Addresses
Primary practice location
17330 113TH Ave
Addisleigh Park, NY 11433-4003
Mailing address
17330 113TH Ave
Addisleigh Park, NY 11433-4003
Phone (718) 207-3292
Other providers in Addisleigh Park, NY
All providers in Addisleigh Park, NY · Occupational Therapy Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.