Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 013841-1 | NY |
NPI | 1134369440 |
---|---|
Provider Name | Mr. Christopher Kevin Carden |
First Address | Lake Grove, NY 11755-2004 |
Second Address | Lake Grove, NY 11755-2004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2009 |
Last Update Date | 26/02/2009 |