Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | NY |
NPI | 1376068536 |
---|---|
Provider Name | Javier Alonso Benitez |
First Address | Sunnyside, NY 11104-3606 |
Second Address | Brooklyn, NY 11238-2346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2017 |
Last Update Date | 09/08/2017 |