Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 002571 | NY |
NPI | 1386978724 |
---|---|
Provider Name | Mr. Mark Joseph Mifsud |
First Address | Glen Rock, NJ 07452-1138 |
Second Address | Jackson Heights, NY 11370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2009 |
Last Update Date | 01/10/2009 |