Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 036353 | NY |
NPI | 1013356518 |
---|---|
Provider Name | Mr. Jayvinth Johnson |
First Address | Ocean, NJ 07712-7631 |
Second Address | Ocean, NJ 07712-7631 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 02/12/2019 |