Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 013519 | NY |
NPI | 1124331566 |
---|---|
Provider Name | Mr. David Ari Shepetofsky |
First Address | Staten Island, NY 10314-4349 |
Second Address | Staten Island, NY 10305-3436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2010 |
Last Update Date | 14/07/2010 |