Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 045222-01 | NY |
Y | 213ES0000X | Sports Medicine | 045222-01 | NY |
NPI | 1417593336 |
---|---|
Provider Name | Andrew Stephen Ward |
First Address | New York, NY 10017-7725 |
Second Address | New York, NY 10017-7725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/11/2019 |
Last Update Date | 26/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045222-01 | PHYSICAL THERAPY LICENSE (01) | NY |