Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | MC05893 | NJ |
NPI | 1114148806 |
---|---|
Provider Name | Dr. Gardy Vastey |
First Address | Irvington, NJ 07111 |
Second Address | Irvington, NJ 07111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |