Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 008986-1 | NY |
NPI | 1023562477 |
---|---|
Provider Name | Mr. Eduardo Rivero Correa |
First Address | Plainsboro, NJ 08536-2233 |
Second Address | Plainsboro, NJ 08536-2233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2016 |
Last Update Date | 14/08/2016 |