Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 011795-1 | NY |
N | 225XG0600X | Occupational Therapist - Gerontology | 011795-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 011795-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 011795-1 | NY |
NPI | 1730533068 |
---|---|
Provider Name | Benito Antonio Flores |
First Address | Bronx, NY 10462-3652 |
Second Address | Bronx, NY 10462-3652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2016 |
Last Update Date | 03/04/2021 |