Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 022581 | NY |
NPI | 1023510450 |
---|---|
Provider Name | Dr. Joshua Lawrence Korth |
First Address | New York, NY 10025-5737 |
Second Address | New York, NY 10003-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2018 |
Last Update Date | 01/03/2018 |