Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 026895-1 | NY |
Y | 225100000X | Physical Therapist | 40QA01178700 | NJ |
NPI | 1003143744 |
---|---|
Provider Name | Jacob Philipose |
First Address | Belleville, NJ 07109-1225 |
Second Address | Belleville, NJ 07109-1225 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2009 |
Last Update Date | 16/11/2009 |