Provider Demographics
NPI:1861783532
Name:SAJOUS JOSEPH, FREDA (OCCUPATIONAL THERAPY)
Entity type:Individual
Prefix:
First Name:FREDA
Middle Name:
Last Name:SAJOUS JOSEPH
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CLOVERFIELD RD N
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2404
Mailing Address - Country:US
Mailing Address - Phone:516-295-0013
Mailing Address - Fax:
Practice Address - Street 1:6 CLOVERFIELD RD N
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-2404
Practice Address - Country:US
Practice Address - Phone:516-295-0013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004891-1224Z00000X, 225XF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistFeeding, Eating & Swallowing
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY004891-1OtherLICENSE