Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 019794 | NY |
NPI | 1295488823 |
---|---|
Provider Name | Jasper S. Delos Reyes |
First Address | Elmhurst, NY 11373-4409 |
Second Address | Elmhurst, NY 11373-4409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2022 |
Last Update Date | 02/02/2022 |