Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 023123-1 | NY |
N | 2251G0304X | Physical Therapist - Geriatrics | 023123-1 | NY |
NPI | 1114136306 |
---|---|
Provider Name | Dr. Joel A Vanslyke |
First Address | Corning, NY 14830-3231 |
Second Address | Corning, NY 14830-3231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |