Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | QA01388500 | NJ |
NPI | 1003114687 |
---|---|
Provider Name | Gregory S Byers |
First Address | Hackensack, NJ 07601-5914 |
Second Address | Hackensack, NJ 07601-5914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2011 |
Last Update Date | 07/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
QA01388500 | LICENSE (01) | NJ |