Provider Demographics
NPI:1174124515
Name:MARKOVITZ, YITZCHOK (OT)
Entity type:Individual
Prefix:
First Name:YITZCHOK
Middle Name:
Last Name:MARKOVITZ
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1152
Mailing Address - Country:US
Mailing Address - Phone:646-549-6511
Mailing Address - Fax:
Practice Address - Street 1:96 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1152
Practice Address - Country:US
Practice Address - Phone:646-549-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00948700225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist