Active NPI
Moriam Soetan
- Occupational Therapist
- Brooklyn, NY
National Provider Identifier
1568242287
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- OT210303
- Practice address
- 1369 Broadway Unit 210536
Brooklyn, NY 11221-8826 - Phone
- (347) 241-5299
- NPI assigned
- Oct 2, 2023
- Last updated
- Oct 2, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | OT61454620 | WA | |
| Occupational Therapist | 225X00000X | OT210303 | CA | Primary |
Addresses
Primary practice location
1369 Broadway Unit 210536
Brooklyn, NY 11221-8826
Mailing address
1369 Broadway Unit 210536
Brooklyn, NY 11221-8826
Phone (347) 241-5299
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 |
|---|---|---|---|
| OT210303 | CA | MD | Occupational Therapist |
| OT61454620 | WA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1696204800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696204800000",
"number": "1568242287",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1369 BROADWAY UNIT 210536",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112218826",
"telephone_number": "347-241-5299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1369 BROADWAY UNIT 210536",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112218826",
"telephone_number": "347-241-5299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOETAN",
"first_name": "MORIAM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-10-02",
"last_updated": "2023-10-02",
"certification_date": "2023-09-30",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WA",
"license": "OT61454620",
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "CA",
"license": "OT210303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brooklyn, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.