Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 46TR00765000 | NJ |
NPI | 1447741319 |
---|---|
Provider Name | Mr. Paul Giordano |
First Address | Nutley, NJ 07110-2712 |
Second Address | Nutley, NJ 07110-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2018 |
Last Update Date | 25/05/2018 |