Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 019864 | NY |
N | 2251C2600X | Cardiopulmonary | 019864 | NY |
NPI | 1063631273 |
---|---|
Provider Name | Mayte Vargas-Di John |
First Address | Great Neck, NY 11020-1057 |
Second Address | Great Neck, NY 11020-1057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2007 |
Last Update Date | 11/02/2008 |