Provider Demographics
NPI:1447495395
Name:SHOLOMOVA, ELEONORA (OTA)
Entity type:Individual
Prefix:
First Name:ELEONORA
Middle Name:
Last Name:SHOLOMOVA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9817 HORACE HARDING EXPY
Mailing Address - Street 2:APT. 4J
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-4248
Mailing Address - Country:US
Mailing Address - Phone:718-271-1259
Mailing Address - Fax:
Practice Address - Street 1:200 WINSTON DR
Practice Address - Street 2:APT. 718
Practice Address - City:CLIFFSIDE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07010-3235
Practice Address - Country:US
Practice Address - Phone:120-188-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-06
Last Update Date:2008-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006568224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant