Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 46TR00752800 | NJ |
NPI | 1003365487 |
---|---|
Provider Name | Kevin Mukalel |
First Address | Union, NJ 07083-5249 |
Second Address | West Orange, NJ 07052-2426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 27/09/2016 |