Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 007636-01 | NY |
NPI | 1750932711 |
---|---|
Provider Name | Melissa Polakoff |
First Address | New City, NY 10956-4425 |
Second Address | New City, NY 10956-4425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2019 |
Last Update Date | 21/09/2019 |