Individual
CHARLES GENREV C NUNAG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
8848 RUTLEDGE AVE, GLENDALE, NY 11385-7934
(929) 231-7460
Mailing address
8848 RUTLEDGE AVE, GLENDALE, NY 11385-7934
(929) 231-7460
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
010380-01
NY
Other
Enumeration date
03/26/2024
Last updated
03/27/2024
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