Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 036359-1 | NY |
NPI | 1063756237 |
---|---|
Provider Name | Diana Mayants |
First Address | New York, NY 10065-4915 |
Second Address | New York, NY 10065-4915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2012 |
Last Update Date | 17/03/2018 |