Provider Demographics
NPI:1053893891
Name:KINGARI, PURITY K (COTA)
Entity type:Individual
Prefix:
First Name:PURITY
Middle Name:K
Last Name:KINGARI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 OLD BERGEN RD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2715
Mailing Address - Country:US
Mailing Address - Phone:316-209-8558
Mailing Address - Fax:
Practice Address - Street 1:299 OLD BERGEN RD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-0730
Practice Address - Country:US
Practice Address - Phone:316-209-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009732-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant