Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1073172292 |
---|---|
Provider Name | Manthan Bachubhai Parmar |
First Address | Woodbridge, NJ 07095-1139 |
Second Address | Brooklyn, NY 11226-1326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2019 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04439 | STATE LICENSE (01) | NY |