Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 40QA01762500 | NJ |
NPI | 1073027165 |
---|---|
Provider Name | Brian Nguyen |
First Address | Vineland, NJ 08360-1815 |
Second Address | Cherry Hill, NJ 08003-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2017 |
Last Update Date | 28/11/2017 |