Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 40QA01923700 | NY |
NPI | 1326658485 |
---|---|
Provider Name | Dr. Andy Seraphin |
First Address | Rockaway, NJ 07866-2421 |
Second Address | Hoboken, NJ 07030-5618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2020 |
Last Update Date | 04/08/2020 |