Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports |
NPI | 1497376297 |
---|---|
Provider Name | Dr. Nicholas Mckaba |
First Address | Long Valley, NJ 07853-3660 |
Second Address | Long Valley, NJ 07853-3660 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2020 |
Last Update Date | 03/05/2020 |