Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 06 022754 | NY |
NPI | 1043586399 |
---|---|
Provider Name | Jasmine Patricia Paredes |
First Address | New York, NY 10036-2345 |
Second Address | New York, NY 10040-3461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2012 |
Last Update Date | 30/03/2012 |