Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 010950 | NY |
Y | 2251G0304X | Physical Therapist - Geriatrics | 010950 | NY |
N | 2251N0400X | Physical Therapist - Neurology | 010950-1 | NY |
NPI | 1134155039 |
---|---|
Provider Name | Mr. James Megna |
First Address | Nesconset, NY 11767-1707 |
Second Address | Nesconset, NY 11767-1707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 04/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2468823 | UNITED HEALTHCARE NUMBER (01) | NY |