Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 014782 | NY |
N | 225XE0001X | Environmental Modification | 014782 | NY |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 014782 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 014782 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 014782 | NY |
NPI | 1700167046 |
---|---|
Provider Name | Edward M Roman |
First Address | New York, NY 10032-1652 |
Second Address | New York, NY 10032-1652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2011 |
Last Update Date | 31/08/2011 |