Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NS0005X | Chiropractic Sports Physician | X009749-1 | NY |
Y | 225X00000X | Occupational Therapist | 017569-1 | NY |
NPI | 1316946239 |
---|---|
Provider Name | Dr. Christopher Wayrich |
First Address | Jericho, NY 11753-2608 |
Second Address | Jericho, NY 11753-2608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 04/10/2012 |