Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 014524-1 | NY |
Y | 2251X0800X | Physical Therapist - Orthopedic | 014524-1 | NY |
NPI | 1063607968 |
---|---|
Provider Name | Mr. Jeffrey Jack Sanoian |
First Address | New City, NY 10956-5260 |
Second Address | New City, NY 10956-5200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 26/04/2012 |