Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 012898 | NY |
NPI | 1013547181 |
---|---|
Provider Name | Livy Dela Cruz |
First Address | Fresh Meadows, NY 11365-2146 |
Second Address | Fresh Meadows, NY 11365-2146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2020 |
Last Update Date | 17/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12898 | (05) | NY |