Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00290700 | NJ |
NPI | 1568532471 |
---|---|
Provider Name | Mr. Gregory R Sanandres |
First Address | Freehold, NJ 07728 |
Second Address | Freehold, NJ 07728-2537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2006 |
Last Update Date | 08/07/2007 |