Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 008975 | NY |
NPI | 1083044093 |
---|---|
Provider Name | Dr. Stacy Michelle Jaffee Gropack |
First Address | Merrick, NY 11566-5035 |
Second Address | Merrick, NY 11566-5035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2013 |
Last Update Date | 13/11/2013 |