Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 025986-1 | NY |
NPI | 1003237165 |
---|---|
Provider Name | George Fouad Antoun |
First Address | Brooklyn, NY 11214-6848 |
Second Address | Brooklyn, NY 11214-6848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2013 |
Last Update Date | 16/12/2013 |