Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 019570-1 | NY |
NPI | 1073613667 |
---|---|
Provider Name | Eric Wing Quan |
First Address | Bethlehem, PA 18017-8236 |
Second Address | New York, NY 10001-5012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2006 |
Last Update Date | 08/07/2007 |