Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 009993-1 | NY |
N | 225XG0600X | Occupational Therapist - Gerontology | 009993 | NY |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 009993-1 | NY |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 009993-1 | NY |
N | 225XP0200X | Occupational Therapist - Pediatrics | 009993-1 | NY |
NPI | 1285941278 |
---|---|
Provider Name | Mr. Conrad Richard Sipa |
First Address | New York, NY 10003-3506 |
Second Address | New York, NY 10003-3506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2010 |
Last Update Date | 25/10/2010 |