Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | 186752 | NY |
NPI | 1013112531 |
---|---|
Provider Name | Fritzner Bourdeau |
First Address | Brooklyn, NY 11210-4117 |
Second Address | Brooklyn, NY 11210-4117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2007 |
Last Update Date | 08/07/2007 |