Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 004369 | NY |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 018212 | NY |
NPI | 1306037874 |
---|---|
Provider Name | Mr. Hector M Rosales |
First Address | Brooklyn, NY 11219-2916 |
Second Address | Brooklyn, NY 11219-2916 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 26/10/2013 |