Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 46TA09147700 | NJ |
NPI | 1023573169 |
---|---|
Provider Name | Mr. Evince Edouard |
First Address | Teaneck, NJ 07666-2331 |
Second Address | Rockleigh, NJ 07647-2504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2019 |
Last Update Date | 14/03/2019 |