Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 012804 | NY |
NPI | 1134754203 |
---|---|
Provider Name | Morris Tolbert JR. |
First Address | New York, NY 10029-3939 |
Second Address | New York, NY 10029-3939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2020 |
Last Update Date | 09/03/2020 |