Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 024448 | NY |
NPI | 1003138975 |
---|---|
Provider Name | Mr. Gerardo Temporal Balid JR. |
First Address | Glen Oaks, NY 11004-1414 |
Second Address | Glen Oaks, NY 11004-1414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2010 |
Last Update Date | 19/02/2010 |