Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 013142-1 | NY |
NPI | 1063646214 |
---|---|
Provider Name | Mr. Eduardo M Sison |
First Address | Ridgefield, NJ 07657-2601 |
Second Address | New Rochelle, NY 10801-5247 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2009 |
Last Update Date | 03/05/2009 |