Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 027980-1 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 027980 | NY |
NPI | 1194988022 |
---|---|
Provider Name | Ace Gonzales Sumagaysay |
First Address | Jamesville, NY 13078-6475 |
Second Address | Jamesville, NY 13078-6475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 06/01/2022 |