Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 039145 | NY |
NPI | 1003282930 |
---|---|
Provider Name | Matthew Macina |
First Address | Whitestone, NY 11357-4142 |
Second Address | New York, NY 10025-6418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2015 |
Last Update Date | 14/08/2015 |