Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 034987 | NY |
NPI | 1003169756 |
---|---|
Provider Name | Kunjan Shah |
First Address | Jackson Heights, NY 11372-1036 |
Second Address | New York, NY 10017-5704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 18/10/2012 |