Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 032753 | NY |
NPI | 1003118480 |
---|---|
Provider Name | Abram John Silas |
First Address | Saint Albans, NY 11412-3424 |
Second Address | Saint Albans, NY 11412-3424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2010 |
Last Update Date | 17/11/2010 |