Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 3243538953 | NY |
NPI | 1265044036 |
---|---|
Provider Name | Joel Gunderson |
First Address | New York, NY 10019-5637 |
Second Address | New York, NY 10019-5637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2020 |
Last Update Date | 21/08/2020 |