Individual
AVIVA NISANOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11506 ROCKAWAY BEACH BLVD, ROCKAWAY PARK, NY 11694-2346
(917) 254-0973
Mailing address
13775 70TH AVE, FLUSHING, NY 11367-1925
(917) 449-2391
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
06/13/2022
Last updated
06/13/2022
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