Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00480200 | NJ |
NPI | 1003147026 |
---|---|
Provider Name | Anthony Goss |
First Address | Verona, NJ 07044 |
Second Address | Verona, NJ 07044 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2010 |
Last Update Date | 15/01/2010 |