Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | NY |
NPI | 1003939802 |
---|---|
Provider Name | Joanne Christine Dubicki |
First Address | Central Islip, NY 11722-3128 |
Second Address | Ronkonkoma, NY 11779-7673 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2007 |
Last Update Date | 08/07/2007 |