Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 001586 | NY |
Y | 2251G0304X | Physical Therapist - Geriatrics | 011586-1 | NY |
NPI | 1336543743 |
---|---|
Provider Name | Molly Olivia Roffman |
First Address | Briarcliff Manor, NY 10510-2096 |
Second Address | Briarcliff Manor, NY 10510-2096 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2014 |
Last Update Date | 01/01/2020 |