Basic Information
| Provider Information | |||||||||
| NPI: | 1669870630 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEB | ||||||||
| FirstName: | ALIZA | ||||||||
| MiddleName: | PERRI | ||||||||
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| OtherOrganizationName: | |||||||||
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| OtherLastName: | BLOBSTEIN | ||||||||
| OtherFirstName: | ALIZA | ||||||||
| OtherMiddleName: | PERRI | ||||||||
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| OtherCredential: | OTR/L | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1651 CONEY ISLAND AVE | ||||||||
| Address2: | OMNI REHAB | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112305849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189981415 | ||||||||
| FaxNumber: | 7186270040 | ||||||||
| Practice Location | |||||||||
| Address1: | 1651 CONEY ISLAND AVE | ||||||||
| Address2: | OMNI REHAB | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112305849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189981415 | ||||||||
| FaxNumber: | 7186270040 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2014 | ||||||||
| LastUpdateDate: | 12/08/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.