Active NPI
Omar Penzo, OTR/L
- Occupational Therapist
- New York, NY
National Provider Identifier
1295108207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 019743-1
- Practice address
- 570 W 190TH St
Apt. 4D
New York, NY 10040-4301 - Phone
- (347) 263-6645
- NPI assigned
- Nov 12, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 019743-1 | NY | Primary |
Addresses
Primary practice location
570 W 190TH St
Apt. 4D
New York, NY 10040-4301
Mailing address
570 W 190TH St
Apt. 4D
New York, NY 10040-4301
Phone (347) 263-6645
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019743-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447286400000",
"number": "1295108207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "570 W 190TH ST",
"address_2": "APT. 4D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100404301",
"telephone_number": "347-263-6645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "570 W 190TH ST",
"address_2": "APT. 4D",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100404301",
"telephone_number": "347-263-6645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PENZO",
"first_name": "OMAR",
"name_prefix": "Mr.",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-12",
"last_updated": "2015-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NY",
"license": "019743-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.