Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 66-001622 | NY |
NPI | 1013019645 |
---|---|
Provider Name | Angel Louis Quinones |
First Address | Carmel, NY 10512-4061 |
Second Address | Brewster, NY 10509-2337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
66-001622 | NYS LICENSE (01) | NY |